Among Low-Income Adults Enrolled In Medicaid, Churning Decreased After The Affordable Care Act

Goldman, Anna L.; Sommers, Benjamin D.

doi:10.1377/hlthaff.2019.00378

Cited by 57 publications

(58 citation statements)

References 22 publications

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“…To date, most research evaluating the effects of the ACA has focused on coverage gains, and none assessed the effects of the ACA on reducing the prevalence or frequency of coverage disruptions and effects on cancer care and outcomes. A recent study found Medicaid expansion was associated with reductions in coverage disruptions in the lowincome general population living in expansion compared with nonexpansion states (59). Given the rapidly changing health insurance landscape in the United States and the maturation of data post-ACA, evaluating the effects of specific provisions of the ACA, especially Medicaid expansions, on coverage disruptions and health outcomes will be important for future research using quasi-experimental designs.…”

Section: Discussionmentioning

confidence: 99%

Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research

Yabroff

Reeder‐Hayes

Zhao

et al. 2020

JNCI: Journal of the National Cancer Institute

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Abstract Background Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival. Methods We conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted and synthesized qualitatively. Results Studies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). Coverage disruptions ranged from 4.3% to 32.8% of patients age-eligible for breast, cervical, or colorectal cancer screening. Between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis. Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment. Among patients with cancer, those with Medicaid disruptions were statistically significantly more likely to have advanced stage (odds ratios = 1.2-3.8) and worse survival (hazard ratios = 1.28-2.43) than patients without disruptions. Conclusions Health insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes.

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Section: Discussionmentioning

confidence: 99%

Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research

Yabroff

Reeder‐Hayes

Zhao

et al. 2020

JNCI: Journal of the National Cancer Institute

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“…A potential concern may be if individuals gain and lose coverage between 2014 and 2018 as their personal situations change; this would hinder my ability to estimate long‐term effects of insurance coverage. However, recent findings that Medicaid expansion is associated with increases in continuous coverage and lower rates of disrupted coverage provide reassuring evidence that insurance transitions between 2014 and 2018 may be less of a concern (Goldman & Sommers, 2020; Gordon, Sommers, Wilson, Galarraga, & Trivedi, 2019). Finally, potential time‐varying confounders may bias my DD results, though findings from my parallel trends and falsification tests partially address this concern.…”

Section: Discussionmentioning

confidence: 99%

“…Either way, studying how low-income people's health behaviors respond to changes in public insurance eligibility is vital for policy evaluation. Given the ongoing policy discussions about expanding public health insurance options in the future (Sommers, 2020), more work studying the longer term effects of public coverage is clearly warranted. This paper builds on earlier studies examining the first 2 years (2014)(2015) or the first 3 years of data (2014-2016) since the 2014 Medicaid expansions.…”

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confidence: 99%

The effects of public health insurance on health behaviors: Evidence from the fifth year of Medicaid expansion

Soni

2020

Health Economics

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This study examines the longer term relationship between public health insurance expansions and health behaviors. I leverage geographic and temporal variation in the implementation of the Affordable Care Act-facilitated Medicaid expansions and provide the first estimates of the expansions' behavioral impacts during their first 5 years. Using national survey data from the 2010 to 2018 Behavioral Risk Factors Surveillance System and a difference-indifferences regression design, I show that the Medicaid expansions increase utilization of certain forms of preventive care, while reducing heavy drinking. I also find suggestive evidence that the expansions reduce smoking and increase the probability of exercise. These results stand in contrast with earlier studies that used only 2 or 3 years of postexpansion data and found no detectable effect of the Medicaid expansions on health behaviors in the short run. My results, combined with evidence from previous studies, suggest that public insurance expansions may not prompt an immediate change in health behaviors, but newly eligible populations do increase investments in healthy behaviors over time. In the long run, Medicaid expansions may help reduce engagement in risky behaviors like drinking and smoking among low-income people.

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“…In the private health insurance market patients enrolled in Exclusive, Provider Plans, Preferred Provider Plans and Health Maintenance Organizations, had plan switching rates of 27%, 24% and 13%, respectively in 2015, though rates are higher in HSA plans, 51% [33]. Medicaid enrollees have rates of coverage disruption of 23.8% in the Affordable Care Act "non-expansion" states, and 9.7% in the expansion states [34]. By contrast, such "churn" is far lower in the Veterans Affairs Health System, which cares for many ex-military patients with PTSD.…”

Section: Plos Onementioning

confidence: 99%

The cost-effectiveness of MDMA-assisted psychotherapy for the treatment of chronic, treatment-resistant PTSD

et al. 2020

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Background Chronic posttraumatic stress disorder (PTSD) is a disabling condition that generates considerable morbidity, mortality, and both medical and indirect social costs. Treatment options are limited. A novel therapy using 3,4-methylenedioxymethamphetamine (MDMA) has shown efficacy in six phase 2 trials. Its cost-effectiveness is unknown. Methods and findings To assess the cost-effectiveness of MDMA-assisted psychotherapy (MAP) from the health care payer's perspective, we constructed a decision-analytic Markov model to portray the costs and health benefits of treating patients with chronic, severe, or extreme, treatmentresistant PTSD with MAP. In six double-blind phase 2 trials, MAP consisted of a mean of 2.5 90-minute trauma-focused psychotherapy sessions before two 8-hour sessions with MDMA (mean dose of 125 mg), followed by a mean of 3.5 integration sessions for each active session. The control group received an inactive placebo or 25-40 mg. of MDMA, and otherwise followed the same regimen. Our model calculates net medical costs, mortality, qualityadjusted life-years (QALYs), and incremental cost-effectiveness ratios. Efficacy was based on the pooled results of six randomized controlled phase 2 trials with 105 subjects; and a four-year follow-up of 19 subjects. Other inputs were based on published literature and on assumptions when data were unavailable. We modeled results over a 30-year analytic horizon and conducted extensive sensitivity analyses. Our model calculates expected medical costs, mortality, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Future costs and QALYs were discounted at 3% per year. For 1,000 individuals, MAP generates discounted net savings of $103.2 million over 30 years while accruing 5,553 discounted QALYs, compared to continued standard of care. MAP breaks even on cost at 3.1 years while delivering 918 QALYs. Making the conservative assumption that benefits cease after one year, MAP would accrue net costs of $7.6 million while generating 288 QALYS, or $26,427 per QALY gained.

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Among Low-Income Adults Enrolled In Medicaid, Churning Decreased After The Affordable Care Act

Cited by 57 publications

References 22 publications

Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research

Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research

The effects of public health insurance on health behaviors: Evidence from the fifth year of Medicaid expansion

The cost-effectiveness of MDMA-assisted psychotherapy for the treatment of chronic, treatment-resistant PTSD

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