All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act

Garthwaite, Craig; Graves, John A.; Gross, Tal; Karaca, Zeynal; Marone, Victoria; Notowidigdo, Matthew

doi:10.3386/w26289

Cited by 16 publications

(23 citation statements)

References 22 publications

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“…This finding also supports the observation that the population newly eligible for Medicaid after expansion may have had unmet LTC needs before expansion. 18 …”

Section: Discussionmentioning

confidence: 99%

“…This finding also supports the observation that the population newly eligible for Medicaid after expansion may have had unmet LTC needs before expansion. 18 Medicaid coverage expansion was associated with a larger increase in home-based service use than in nursing home use. The increase in use of home health fits with the conventional wisdom that individuals would generally prefer to receive LTC services in the least-restrictive setting possible.…”

Section: Jama Network Open | Health Policymentioning

confidence: 92%

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Association of Medicaid Expansion Under the Patient Protection and Affordable Care Act With Use of Long-term Care

et al. 2020

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“…This finding also supports the observation that the population newly eligible for Medicaid after expansion may have had unmet LTC needs before expansion. 18 …”

Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Health Policymentioning

confidence: 92%

Association of Medicaid Expansion Under the Patient Protection and Affordable Care Act With Use of Long-term Care

et al. 2020

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“…Accordingly, difference‐in‐difference and triple‐difference regression models were employed in order to control for confounding variables. Work by Garthwaite et al (2019) informed the creation of these specifications. The details of the regression models are described below.…”

Section: Resultsmentioning

confidence: 99%

“…These additional factors can include different exposures to subsidised coverage in eligible populations at insurance exchanges or varying roll‐outs of Medicaid expansion. These state‐level factors could result in imprecise estimates of the true relationship between health insurance coverage and diabetes diagnoses (Garthwaite et al, 2019). For these reasons, a triple difference (difference‐in‐difference‐in‐differences) specification was created:

Y = β * {Post}_{t} * italicShareEligi italicb {le}_{c} + α_{c} + {ShareEligible}_{c} * a_{t} + α_{s} * α_{t} + p + e + ε_{cst} .

…”

Section: Resultsmentioning

confidence: 99%

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Impact of the Affordable Care Act on diabetes diagnoses in the United States: A county‐level analysis

2021

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Our research examines whether there is a causal effect between expanding health insurance and diabetes incidence. Comprehensive county‐level data from the United States is used to study the effect of Medicaid expansion on diabetes rates. The analysis is based on cross‐county variation according to Affordable Care Act health care reforms, along with county share‐eligibility variation. Difference‐in‐difference and triple‐difference statistical regression specifications are employed to control for confounding variables. The results suggest a slight negative relationship between expanding health insurance and diabetes diagnoses.

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Examination of Elective Bariatric Surgery Rates Before and After US Affordable Care Act Medicaid Expansion

Hanchate

Qi²,

Lasser

et al. 2021

JAMA Health Forum

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IMPORTANCE There is limited evidence on whether the Affordable Care Act Medicaid expansion beginning in 2014 improved access to elective procedures. Uninsured individuals are at higher risk of obesity and may have experienced improved uptake of bariatric surgery following Medicaid expansion. OBJECTIVETo examine the association between Medicaid expansion and the receipt of inpatient elective bariatric surgery among Medicaid-covered and uninsured individuals aged 26 to 64 years. DESIGN, SETTING, AND PARTICIPANTS This cohort study used difference-in-differences analysis of all-payer data (2010-2017) of 637 557 elective bariatric surgeries for patients aged 26 to 74 years from 11 Medicaid expansion states and 6 nonexpansion states. Nonexpansion states and individuals aged 65 to 74 years were control cohorts. Data analysis was performed from July 6, 2020, to July 23, 2021. EXPOSURE Living in a Medicaid expansion state. MAIN OUTCOMES AND MEASURES The main outcomes were the (1) number of elective bariatric surgeries, (2) population count, and (3) rate of bariatric surgery (number of surgeries per 10 000 population) among Medicaid-covered and uninsured individuals. RESULTS Of the 600 798 elective bariatric surgeries in adults aged 26 to 64 years between 2010 and 2017 from the 17 study states, Medicaid-covered and uninsured individuals accounted for 18.3%of the total surgery volume in expansion states and 14.5% in nonexpansion states. A total of 296 798 patients (78.9%) in expansion states were women vs 177 386 (78.9%) in nonexpansion states.Among individuals aged 26 to 64 years, the median age was 44 (IQR, 37-52) years. Racial and ethnic distribution was non-Hispanic White, 60.2%; non-Hispanic Black, 17.7%; Hispanic, 16.6%; and other, 5.5%. Between 2013 and 2017, the volume of bariatric surgeries for Medicaid-covered and uninsured patients increased annually by 30.3% in expansion states and 16.5% in nonexpansion states.Medicaid expansion was associated with a 36.6% annual increase (95% CI, 8.2% to 72.5%) in surgery volume, a 9.0% annual increase (95% CI, 3.8% to 14.5%) in the population, and a 25.5% change (95% CI, -1.3% to 59.4%) in the rate of bariatric surgery. By race and ethnicity, Medicaid expansion was associated with an increase in the rate of bariatric surgery among non-Hispanic White individuals (31.6%; 95% CI, 6.1% to 63.0%) but no significant change among non-Hispanic Black (5.9%; 95% CI, -19.8% to 39.9%) and Hispanic (28.9%; 95% CI, -24.4% to 119.8%) individuals.CONCLUSIONS AND RELEVANCE This cohort study found that Medicaid expansion was associated with increased rates of bariatric surgery among lower-income non-Hispanic White individuals, but not among Hispanic and non-Hispanic Black individuals.

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All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act

Cited by 16 publications

References 22 publications

Association of Medicaid Expansion Under the Patient Protection and Affordable Care Act With Use of Long-term Care

Association of Medicaid Expansion Under the Patient Protection and Affordable Care Act With Use of Long-term Care

Impact of the Affordable Care Act on diabetes diagnoses in the United States: A county‐level analysis

Examination of Elective Bariatric Surgery Rates Before and After US Affordable Care Act Medicaid Expansion

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