Medicaid Expansion Produces Long-Term Impact on Insurance Coverage Rates in Community Health Centers

Huguet, Nathalie; Hoopes, Megan; Angier, Heather; Holderness, Heather; DeVoe, Jennifer E.

doi:10.1177/2150131917709403

Cited by 31 publications

(34 citation statements)

References 9 publications

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“…The ACA led to increased access to health care services for patients seen in CHCs. 6,12 This in- . The retrospective cohort of established patients included those who were uninsured at their last visit pre-ACA (2012 to 2013) and gained insurance coverage post-ACA (2014 to 2015).…”

Section: Discussionmentioning

confidence: 95%

Prevalence of Pre-existing Conditions Among Community Health Center Patients Before and After the Affordable Care Act

et al. 2019

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To assess the prevalence of pre-existing conditions for community health center (CHC) patients who gained insurance coverage post-Affordable Care Act (ACA). Methods: We analyzed electronic health record data from 78,059 patients aged 19 to 64 uninsured at their last visit pre-ACA from 386 CHCs in 19 states. We compared the prevalence and types of pre-existing conditions pre-ACA (2012 to 2013) and post-ACA (2014 to 2015), by insurance status and race/ethnicity. Results: Pre-ACA, >50% of patients in the cohort had >1 Pre-existing condition. Post-ACA, >70% of those who gained insurance coverage had >1 condition. Post-ACA, all racial/ethnic subgroups showed an increase in the number of pre-existing conditions, with non-Hispanic Black and Hispanic patients experiencing the largest increases (adjusted prevalence difference, 18.9; 95% CI, 18.2 to 19.6 and 18.3; 95% CI, 17.8 to 18.7, respectively). The most common conditions post-ACA were mental health disorders with the highest prevalence among patients who gained Medicaid (45.6%) and lowest among those who gained private coverage (30.5%). Conclusions: This study emphasizes the high prevalence of pre-existing conditions among CHC patients and the large increase in the proportion of patients with at least 1 of these diagnoses post-ACA. Given how common these conditions are, repealing pre-existing condition protections could be extremely harmful to millions of patients and would likely exacerbate health care and health disparities.

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Section: Discussionmentioning

confidence: 95%

Prevalence of Pre-existing Conditions Among Community Health Center Patients Before and After the Affordable Care Act

et al. 2019

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“…Additional funding to support CHCs will be needed for them to continue to provide care for increasing numbers of uninsured patients. Although prior studies have shown that the ACA improved access to health insurance and decreased uninsurance rates, [6][7][8][9][10] none have examined changes in Visits refer to overall ambulatory care use, which includes all billable encounters.…”

Section: Discussionmentioning

confidence: 99%

“…4 The ACA augmented funding for CHCs for 5 years (through 2017), which was renewed in early 2018, allowing them to continue to provide care for the uninsured, assist insured patients with significant out-of-pocket expenses, and provide services not covered by health insurance. 5,6 Post-ACA, CHCs experienced an increase in both Medicaid-paid visits and privately insured visits [6][7][8][9][10] and corresponding decreases in uninsured visits. More than 6 million patients seen at CHCs across the nation, however, remain uninsured.…”

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confidence: 99%

Following Uninsured Patients Through Medicaid Expansion: Ambulatory Care Use and Diagnosed Conditions

et al. 2019

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PURPOSE The Patient Protection and Affordable Care Act (ACA) has improved access to health insurance, yet millions remain uninsured. Many patients who remain uninsured access care at community health centers (CHCs); however, little is known about their health conditions and health care use. We assessed ambulatory care use and diagnosed health conditions among a cohort of CHC patients uninsured before enactment of the ACA (pre-ACA: January 1, 2012 to December 31, 2013) and followed them after enactment (post-ACA: January 1, 2014 to December 31, 2015). METHODS This retrospective cohort analysis used electronic health record data from CHCs in 11 US states that expanded Medicaid eligibility. We assessed ambulatory care visits and documented health conditions among a cohort of 138,246 patients (aged 19 to 64 years) who were uninsured pre-ACA and either remained uninsured, gained Medicaid, gained other health insurance, or did not have a visit post-ACA. We estimated adjusted predicted probabilities of ambulatory care use using an ordinal logistic mixed-effects regression model. RESULTS Post-ACA, 20.9% of patients remained uninsured, 15.0% gained Medicaid, 12.4% gained other insurance, and 51.7% did not have a visit. The majority of patients had ≥1 diagnosed health condition. The adjusted proportion of patients with high use (≥6 visits over 2 years) increased from pre-ACA to post-ACA among those who gained Medicaid (pre-ACA: 23%, post-ACA: 34%, P <.001) or gained other insurance (pre-ACA: 29%, post-ACA: 48%, P <.001), whereas the percentage fell slightly for those continuously uninsured. CONCLUSIONS A significant percentage of CHC patients remained uninsured; many who remained uninsured had diagnosed health conditions, and one-half continued to have ≥3 visits to CHCs. CHCs continue to be essential providers for uninsured patients.

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“…Uninsurance rates among CHC patients decreased dramatically after the ACA, particularly in states that expanded Medicaid eligibility. 9 For example, rates of uninsured visits to CHCs decreased 57% from the period before the ACA to the period after the ACA in expansion states, whereas nonexpansion states saw a 20% decrease; however, Medicaid-insured visits increased by 60% in expansion states and remained unchanged in nonexpansion states. 9 Cancer July 15, 2020…”

Section: Introductionmentioning

confidence: 99%

The Affordable Care Act improved health insurance coverage and cardiovascular‐related screening rates for cancer survivors seen in community health centers

Angier

Springer

Schmidt

et al. 2020

Cancer

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BACKGROUND: This study assessed the impact of Affordable Care Act (ACA) Medicaid expansion on health insurance rates and receipt of cardiovascular-related preventive screenings (body mass index, glycated hemoglobin [HbA1c], low-density lipoproteins, and blood pressure) for cancer survivors seen in community health centers (CHCs). METHODS: This study identified cancer survivors aged 19 to 64 years with at least 3 CHC visits in 13 states from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE). Via inverse probability of treatment weighting multilevel multinomial modeling, insurance rates before and after the ACA were estimated by whether a patient lived in a state that expanded Medicaid, and changes between a pre-ACA time period and 2 post-ACA time periods were assessed. RESULTS: The weighted estimated sample size included 409 cancer survivors in nonexpansion states and 2650 in expansion states. In expansion states, the proportion of uninsured cancer survivors decreased significantly from 20.3% in 2012-2013 to 4.5%in 2016-2017, and the proportion of those with Medicaid coverage increased significantly from 38.8% to 55.6%. In nonexpansion states, there was a small decrease in uninsurance rates (from 33.6% in 2012-2013 to 22.5% in 2016-2017). Cardiovascularrelated preventive screening rates increased over time in both expansion and nonexpansion states: HbA1c rates nearly doubled from the pre-ACA period (2012-2013) to the post-ACA period (2016-2017) in expansion states (from 7.2% to 12.8%) and nonexpansion states (from 9.3% to 16.8%). CONCLUSIONS: This study found a substantial decline in uninsured visits among cancer survivors in Medicaid expansion states. Yet, 1 in 5 cancer survivors living in a state that did not expand Medicaid remained uninsured. Several ACA provisions likely worked together to increase cardiovascular-related preventive screening rates for cancer survivors seen in CHCs.

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Medicaid Expansion Produces Long-Term Impact on Insurance Coverage Rates in Community Health Centers

Cited by 31 publications

References 9 publications

Prevalence of Pre-existing Conditions Among Community Health Center Patients Before and After the Affordable Care Act

Prevalence of Pre-existing Conditions Among Community Health Center Patients Before and After the Affordable Care Act

Following Uninsured Patients Through Medicaid Expansion: Ambulatory Care Use and Diagnosed Conditions

The Affordable Care Act improved health insurance coverage and cardiovascular‐related screening rates for cancer survivors seen in community health centers

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