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:10.1353/eca.2019.0012

Cited by 10 publications

(16 citation statements)

References 37 publications

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“…44 Previous work with diverging results generally assessed changes in ED visits after 1 or 2 years postexpansion, focused their analysis on different states and populations, or reviewed outcomes using different definitions of not-emergent ED visits. 25,31,32 The observed decreases in ED visits concurrently occurred with increases in availability and access to primary care, and more primary care professionals accepting patients with Medicaid coverage to higher Medicaid payment rates. 17,25,43,[45][46][47] Furthermore, decreases in Medicaid expansion states were concentrated in conditions that were less-emergent or not medically emergent, suggesting that access to preventive services could have substituted ED visits, improved health, and stabilized health conditions, which rendered ED use not necessary.…”

Section: Expansion States Nonexpansion Statesmentioning

confidence: 99%

Association of Medicaid Expansion With Emergency Department Visits by Medical Urgency

2022

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Key Points Question Is Medicaid eligibility expansion associated with changes in emergency department (ED) visits based on the medical urgency of the conditions? Findings In this cross-sectional study of 80.6 million ED visits across 4 US states, ED visits per 1000 population decreased for states that expanded Medicaid compared with states that did not. This decrease was associated with decreases in ED visits for less-emergent or nonemergent conditions. Meaning The findings of this study suggest that expanding Medicaid might reduce ED visits for conditions that could be treated in outpatient settings.

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Section: Expansion States Nonexpansion Statesmentioning

confidence: 99%

Association of Medicaid Expansion With Emergency Department Visits by Medical Urgency

2022

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“…These results highlight the importance of understanding how the effects of public insurance programs differ by locality and race and ethnicity when assessing their potential to advance health equity. 42 Our findings also suggest that expanding Medicare may be a viable means to reduce racial and ethnic disparities and advance health equity by closing coverage gaps across the US.…”

Section: Hispanic Respondentsmentioning

confidence: 58%

Changes in Racial and Ethnic Disparities in Access to Care and Health Among US Adults at Age 65 Years

et al. 2021

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IMPORTANCE Medicare provides nearly universal health insurance to individuals at age 65 years. How eligibility for Medicare affects racial and ethnic disparities in access to care and health is poorly understood. OBJECTIVE To assess the association of Medicare with racial and ethnic disparities in access to care and health. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study uses regression discontinuity to compare racial and ethnic disparities before and after age 65 years, the age at which US adults are eligible for Medicare. There are a total of 2 434 320 respondents in the Behavioral Risk Factor Surveillance System and 44 587 state-age-year observations in the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Data (eg, the mortality rate for individuals age 63 years in New York in 2017) from January 2008 to December 2018. The data were analyzed between February and May 2021. EXPOSURES Eligibility for Medicare at age 65 years.MAIN OUTCOMES AND MEASURES Proportions of respondents with health insurance, as well as self-reported health and mortality. To examine access, whether respondents had a usual source of care, encountered cost-related barriers to care, or received influenza vaccines was assessed. RESULTSOf 2 434 320 participants, 192 346 were Black individuals, 104 294 were Hispanic individuals, and 892 177 were men. Immediately after age 65 years, insurance coverage increased more for Black respondents (from 86.3% to 95.8% or 9.5 percentage points; 95% CI, 7.6-11.4) and Hispanic respondents (from 77.4% to 91.3% or 13.9 percentage points; 95% CI, 12.0-15.8) than White respondents (from 92.0% to 98.5% or 6.5 percentage points; 95% CI, 6.1-7.0). This was associated with a 53% reduction compared with the size of the disparity between White and Black individuals before age 65 years (5.7% to 2.7% or 3.0 percentage points; 95% CI, 0.9-5.1; P = .003) and a 51% reduction compared with the size of the disparity between White and Hispanic individuals before age 65 years (14.6% to 7.2% or 7.4 percentage points; 95% CI, 5.3-9.5; P < .001). Medicare eligibility was associated with narrowed disparities between White and Hispanic individuals in access to care, lowering disparities in access to a usual source of care from 10.5% to 7.5% (P = .05), cost-related barriers to care from 11.4% to 6.9% (P < .001), and influenza vaccination rates from 8.1% to 3.3% (P = .01). For disparities between White and Black individuals, access to a usual source of care before and after age 65 years was not significantly different: 1.2% to 0.0% (P = .24), cost-related barriers to care from 5.8% to 4.3% (P = .22), and influenza vaccinations from 11.0% to 10.3% (P = .60). The share of people in poor self-reported health decreased by 3.8 percentage points for Hispanic respondents, 2.6 percentage points for Black respondents, and 0.2 percentage points for White respondents. Mortality-related disparities at age 65 years were unchanged. Medicare's association with reduced disparities largely p...

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“…Although Giannouchos et al 3 found encouraging patterns of ED use, other studies have found the opposite. In particular, a 2019 study by Garthwaite et al, 8 which also used Healthcare Cost and Utilization Project data, but included 20 states and all ED visits (both outpatient ED visits as well as those leading to inpatient admission), found that ED use for deferrable conditions increased in expansion states relative to nonexpansion states, whereas those for nondeferrable conditions did not. The authors defined deferrable conditions as those that a panel of physicians believed were likely to be at the patient's discretion, and nondeferrable conditions as those that were truly emergent and not likely to be discretionary.…”

Section: + Related Articlementioning

confidence: 99%

Medicaid Expansion and Avoidable Emergency Department Use—Implications for US National and State Government Spending

Sabbatini

Dugan

2022

JAMA Netw Open

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

Cited by 10 publications

References 37 publications

Association of Medicaid Expansion With Emergency Department Visits by Medical Urgency

Association of Medicaid Expansion With Emergency Department Visits by Medical Urgency

Changes in Racial and Ethnic Disparities in Access to Care and Health Among US Adults at Age 65 Years

Medicaid Expansion and Avoidable Emergency Department Use—Implications for US National and State Government Spending

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