Association of Expanded Medicaid Coverage With Hospital Length of Stay After Injury

Holzmacher, Jeremy L.; Townsend, Kerry; Seavey, Caleb N.; Gannon, Stephanie; Schroeder, Mary; Gondek, Stephen; Collins, Lois; Amdur, Richard L.; Sarani, Babak

doi:10.1001/jamasurg.2017.1720

Cited by 20 publications

(19 citation statements)

References 27 publications

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“…The observed increase in LOS in our study was negated after removing Maryland from the analysis, mirroring previous studies that have found that changes in LOS among trauma patients after Medicaid expansion varied by state and injury severity. 8 , 25 , 59 , 60 The paucity of post-discharge care facilities in some regions can create a bottleneck for patients awaiting discharge to these specialized services and, when combined with variation across states and hospitals over time in decision making about admitting vs observing nonseverely injured patients, contributes to variability in LOS among admitted trauma patients. 61 In contrast, the difference in reported access to home healthcare is likely a result of study cohort selection.…”

Section: Discussionmentioning

confidence: 99%

Association of the Affordable Care Act Medicaid Expansion with Trauma Outcomes and Access to Rehabilitation among Young Adults: Findings Overall, by Race and Ethnicity, and Community Income Level

Metzger

Asti

Quinn

et al. 2021

Journal of the American College of Surgeons

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BACKGROUND: Low-income young adults disproportionately experience traumatic injury and poor trauma outcomes. This study aimed to evaluate the effects of the Affordable Care Act's Medicaid expansion, in its first 4 years, on trauma care and outcomes in young adults, overall and by race, ethnicity, and ZIP code-level median income. STUDY DESIGN: Statewide hospital discharge data from 5 states that did and 5 states that did not implement Medicaid expansion were used to perform difference-in-difference (DD) analyses. Changes in insurance coverage and outcomes from before (2011-2013) to after (2014-2017) Medicaid expansion and open enrollment were examined in trauma patients aged 19 to 44 years. RESULTS:Medicaid expansion was associated with a decrease in the percentage of uninsured patients (DD e16.5 percentage points; 95% CI, e17.1 to e15.9 percentage points). This decrease was larger among Black patients but smaller among Hispanic patients than White patients. It was also larger among patients from lower-income ZIP codes (p < 0.05 for all). Medicaid expansion was associated with an increase in discharge to inpatient rehabilitation (DD 0.6 percentage points; 95% CI, 0.2 to 0.9 percentage points). This increase was larger among patients from the lowest-compared with highest-income ZIP codes (p < 0.05). Medicaid expansion was not associated with changes in in-hospital mortality or readmission or return ED visit rates overall, but was associated with decreased in-hospital mortality among Black patients (DD e0.4 percentage points; 95% CI, e0.8 to e0.1 percentage points). CONCLUSIONS: The Affordable Care Act Medicaid expansion, in its first 4 years, increased insurance coverage and access to rehabilitation among young adult trauma patients. It also reduced the socioeconomic disparity in inpatient rehabilitation access and the disparity in in-hospital mortality between Black and White patients.

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Section: Discussionmentioning

confidence: 99%

Association of the Affordable Care Act Medicaid Expansion with Trauma Outcomes and Access to Rehabilitation among Young Adults: Findings Overall, by Race and Ethnicity, and Community Income Level

Metzger

Asti

Quinn

et al. 2021

Journal of the American College of Surgeons

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“…California is 1 of only 32 states that participated in Medicaid expansion, and despite initial evidence to date of improved hospital revenues as a consequence of insurance gains, further study is required both at local and national levels in order to better understand the implications of recent and forthcoming changes in policy. 17,20 Another objective of insurance expansion legislation was to improve quality of health care, but the impact on quality of injury-related care is still being elucidated. Disparities in health outcomes based on insurance status are established in surgery and trauma.…”

Section: Discussionmentioning

confidence: 99%

Financial Stability of Level I Trauma Centers Within Safety-Net Hospitals

Knowlton

Morris

Tennakoon

et al. 2018

Journal of the American College of Surgeons

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“…8 Individual studies have shown that expansion also correlates with declines in non-emergent use of the emergency department 9 and lengths of hospital stays. 10,11 Yet Medicaid expansion is no panacea. Many providers are reluctant to accept new Medicaid patients due to low reimbursement rates, which can limit de facto access to care.…”

Section: Millions Of People Are Still Uninsuredmentioning

confidence: 99%

The Affordable Care Act 10 Years In

McGee¹,

Breslin²

2021

Nurse Leader

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The Affordable Care Act (ACA) introduced wide-ranging health care reforms but faces many challenges. This article reviews 6 key points for today's nurse leader on the law's 10th anniversary: a renewed legal battle is on its way to the Supreme Court; 27 million people still lack coverage, partly due to nonexpansion of Medicaid in 15 states; Medicaid waivers provide coverage for some low-income people but leave many people out; value-based purchasing has allocated billions of dollars in rewards and penalties; ACA Marketplace plans are not always affordable, but premiums are stabilizing; and the 2020 elections could result in dramatic consequences for health care reform.Note: The authors have stated that they have no conflicts of interest to declare.

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Association of Expanded Medicaid Coverage With Hospital Length of Stay After Injury

Abstract: Expanded Medicaid eligibility is associated with shorter hospital LOS in mildly injured Medicaid recipients.

Cited by 20 publications

References 27 publications

Association of the Affordable Care Act Medicaid Expansion with Trauma Outcomes and Access to Rehabilitation among Young Adults: Findings Overall, by Race and Ethnicity, and Community Income Level

Association of the Affordable Care Act Medicaid Expansion with Trauma Outcomes and Access to Rehabilitation among Young Adults: Findings Overall, by Race and Ethnicity, and Community Income Level

Financial Stability of Level I Trauma Centers Within Safety-Net Hospitals

The Affordable Care Act 10 Years In

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