Coverage and Access for Americans With Chronic Disease Under the Affordable Care Act

Torres, Hugo Amador Herrera; Poorman, Elisabeth; Tadepalli, Uma; Schoettler, Cynthia; Fung, Chin Ho; Mushero, Nicole; Campbell, Lauren; Basu, Gopal; McCormick, Danny

doi:10.7326/m16-1256

Cited by 53 publications

(62 citation statements)

References 22 publications

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“…We confirm (results are in appendix) findings from previous studies [13–16] that nationwide, blacks and Hispanics were less likely to have insurance coverage in the pre-ACA period than non-Hispanic whites were. However, compared to non-Hispanic whites, they also made larger gains in coverage post-ACA.…”

Section: Resultssupporting

confidence: 88%

“…States that elected to expand Medicaid covered all adults up to 133% of Federal Poverty Limit (FPL). That these provisions expanded insurance coverage is evidenced by several studies using datasets such as Gallup-Healthways Wellbeing Index [2, 12], the National Health Interview Survey [14], the American Community Survey [3], the Commonwealth Fund Survey [22] and BRFSS [5, 13, 23].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have found that after ACA health exchanges went into effect and some states expanded Medicaid in 2014, nationwide uninsurance rates dropped substantially, and that gains in insurance were divided equally between gains in Medicaid and private coverage [2–4, 6, 12, 13]. One study has also documented substantial variation across states in gains following ACA [3].…”

Section: Introductionmentioning

confidence: 99%

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Empirical Analyses of Associations between State Political Attitudes and Gains in Health Insurance Coverage after the Affordable Care Act (ACA)

Joseph

2019

Preprint

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32Objectives: To explore whether state-level political-sentiment is associated with gains in 33 insurance post Affordable Care Act (ACA). This is especially relevant given the lawsuit brought 34 by several Republican-leaning states against the ACA, and the ruling of one Texas federal judge 35 that the ACA is unconstitutional, which potentially jeopardizes ACA's future. 36 Methods: Multivariate linear-probability models are estimated using data from the Behavioral 37 Risk Factor Surveillance Systems for 2011-2017. The outcome is self-reported insurance status. 38 States are placed in quartiles based on votes for President Obama in 2008 and 2012 elections. 39 Starting 2014, ACA health exchanges became active and several states expanded Medicaid, so 40 2014 onwards is considered as the 'post-ACA' period. Models are estimated for all adults under 41 65-years and for young adults under 35-years. All models control extensively for respondent socio-42 economic-demographic characteristics and state characteristics.43 Results: In the pre-ACA baseline period, respondents in states with higher Anti-Obama-voting 44 (AOV) were less likely to have insurance. For example, residents in highest AOV-quartile states 45 were 8.0-percentage-points less likely (p<0.001) to have insurance than those in the lowest AOV-46 quartile states. Post-ACA, fewer high AOV-quartile states expanded Medicaid, and overall 47 48 Medicaid-expansion, residents in higher AOV states saw higher insurance gains. For example, all 49 adults had 2.8-percentage points higher likelihood (p<0.01) and young adults had 4.9-percentage 50 point higher likelihood (p<0.01) of getting insurance in the highest AOV-quartile states compared 51 to the lowest AOV quartile states. Minorities and those with chronic-conditions had larger 52 insurance gains across the country post-ACA, but the extent of these gains did not differ by state 53 AOV levels. 3 54 Conclusions: State AOV and insurance gains from ACA appear to be incongruent. Policymakers 55 and stakeholders should be aware that non-Medicaid residents of higher-AOV states might 56 potentially lose the most if ACA is revoked. 58 The Patient Protection and Affordable Care Act (hereafter ACA) very substantially 59 changed the health insurance landscape in the United States, and scientific research indicates that 60 although there were significant increases in rates of health insurance coverage in the U.S. after 61 its passage, yet opinions about the ACA remain deeply divided along political lines [1-6]. The 62Kaiser Health Tracking Poll [7] shows that overall unfavorable ratings of ACA dropped from a 63 high of 53% in July 2014 to 40% in November 2018. However, among those who identify as 64 Republicans, approximately 75% continue to view it unfavorably, while less than 20% of those 65 who identify as Democrats and about 45% of those who identify as Independents do so. The 66 ACA's future also remains uncertain under the current administration. One key provision, the 67 'individual mandate' that requires indiv...

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Section: Resultssupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Empirical Analyses of Associations between State Political Attitudes and Gains in Health Insurance Coverage after the Affordable Care Act (ACA)

Joseph

2019

Preprint

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“…16,17 Previous work has indicated that the young adult expansion of employer-sponsored insurance resulted in increases in coverage among cancer survivors aged 19 to 25 years, 18 including greater access to health care through an earlier stage of disease at diagnosis. 12 Medicaid expansion has increased coverage and access to care among lowincome adults, 19,20 and has been associated with increased insurance rates among newly diagnosed patients with cancer. 21 Although Medicaid expansion has the potential to affect affordability and access to medical care among lowincome cancer survivors, 3 to the best of our knowledge the effect on physician access and affordability of care among cancer survivors has not yet been investigated.…”

Section: Althoughmentioning

confidence: 99%

Patient Protection and Affordable Care Act Medicaid expansion and gains in health insurance coverage and access among cancer survivors

Nikpay

Tebbs

Castellanos

2018

Cancer

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“…Finally, individuals with chronic conditions are most likely to benefit from insurance expansion because they require ongoing treatment and management and are more sensitive to high levels of cost-sharing. 15,16 Stratifying analyses by chronic condition status can focus on meaningful health improvements among the population most likely to benefit. Moreover, chronic conditions are more prevalent among childless adults than other adults who gained coverage through the Affordable Care Act.…”

Section: Introductionmentioning

confidence: 99%

Medicaid Expansion, Mental Health, and Access to Care among Childless Adults with and without Chronic Conditions

Winkelman

Chang

2017

J GEN INTERN MED

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Coverage and Access for Americans With Chronic Disease Under the Affordable Care Act

Abstract: None.

Cited by 53 publications

References 22 publications

Empirical Analyses of Associations between State Political Attitudes and Gains in Health Insurance Coverage after the Affordable Care Act (ACA)

Empirical Analyses of Associations between State Political Attitudes and Gains in Health Insurance Coverage after the Affordable Care Act (ACA)

Patient Protection and Affordable Care Act Medicaid expansion and gains in health insurance coverage and access among cancer survivors

Medicaid Expansion, Mental Health, and Access to Care among Childless Adults with and without Chronic Conditions

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