Simulated Power Analyses for Observational Studies: An Application to the Affordable Care Act Medicaid Expansion

Black, Bernard S.; Hollingsworth, Alex; Nunes, Letícia; Simon, Kosali

doi:10.3386/w25568

Cited by 17 publications

(23 citation statements)

References 52 publications

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“…Study findings can help statisticians, researchers, and policy makers better gauge the validity of the existing evidence base and to conduct sound evaluations of new policies enacted by states. The use of simulation studies to assess the statistical properties of commonly used methods is an innovative yet underutilized approach for helping researchers examine methods' performance in a specific context (Black et al 2019).…”

Section: Discussionmentioning

confidence: 99%

Variation in Performance of Commonly Used Statistical Methods for Estimating Effectiveness of State-Level Opioid Policies on Opioid-Related Mortality

Griffin

Schuler

Stuart

et al. 2020

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This research was financially supported through an NIH grant (P50DA046351) to RAND (PI: Stein). The authors would like to thank Kosali Simon and the participants of the 2019 ASHEcon session that provided helpful comments on an earlier draft. Finally, the authors want to thank Hilary Peterson for her assistance with manuscript preparation and submission. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research. NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.

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Section: Discussionmentioning

confidence: 99%

Variation in Performance of Commonly Used Statistical Methods for Estimating Effectiveness of State-Level Opioid Policies on Opioid-Related Mortality

Griffin

Schuler

Stuart

et al. 2020

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“…We find no significant effect of Medicaid expansion on these alternative definitions of 5 Given that we use state level data, there may be concerns about the ability to detect an effect. Therefore, we conduct a power analysis as recommended by Black, Hollingsworth, Nunes, and Simon (2019). The results of this analysis indicate sufficient power.…”

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confidence: 99%

Medicaid expansion and opioid deaths

2019

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The United States is in the midst of an opioid epidemic, and drug overdose deaths are becoming a leading cause of death. Meanwhile, in 2010, the United States passed comprehensive health care reform providing access to care for millions of individuals who previously lacked care. Part of the new access came from expanding Medicaid, the insurance program for low‐income individuals. Expanding Medicaid was optional for states. Those individuals living in expansion states gained prescription drug coverage and hence more access to opioid pain‐relievers that are known to be addictive. However, they also gained access to medication‐assisted treatment for addiction. This paper uses a difference‐in‐differences approach and state‐level data from 2010 to 2017 to compare opioid death rates in expansion and non‐expansion states to determine if Medicaid expansion was a potential cause of rising opioid deaths. We find no evidence that Medicaid expansion is related to opioid deaths.

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“…The difficulty with assessing mortality changes is that this is (fortunately) a rare event in the U.S. for the non‐elderly, who are the primary focus of the ACA. Indeed, one recent working paper argues that the ACA itself is underpowered to detect any mortality effects at the population level, given that coverage gains occurred in all states, and pre‐ACA trends may preclude using the Medicaid expansion as an identification strategy for this outcome (Black et al., ). A recent working paper by Miller, Altekruse, Johnson, and Wherry () challenges this characterization by matching a large sample of survey data with administrative death records.…”

Section: Effects Of the Aca On Health Care Utilization And Healthmentioning

confidence: 99%

The Affordable Care Act's Effects on Patients, Providers, and the Economy: What We've Learned So Far

Gruber¹,

Sommers²

2019

J Policy Anal Manage

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As we approach the tenth anniversary of the passage of the Affordable Care Act, it is important to reflect on what has been learned about the impacts of this major reform. In this paper, we review the literature on the impacts of the ACA on patients, providers, and the economy. We find strong evidence that the ACA's provisions have increased insurance coverage. There is also a clearly positive effect on access to and consumption of health care, with suggestive but more limited evidence on improved health outcomes. There is no evidence of significant reductions in provider access, changes in labor supply, or increased budgetary pressures on state governments, and the law's total federal cost through 2018 has been less than predicted. We conclude by describing key policy implications and future areas for research.

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Simulated Power Analyses for Observational Studies: An Application to the Affordable Care Act Medicaid Expansion

Cited by 17 publications

References 52 publications

Variation in Performance of Commonly Used Statistical Methods for Estimating Effectiveness of State-Level Opioid Policies on Opioid-Related Mortality

Variation in Performance of Commonly Used Statistical Methods for Estimating Effectiveness of State-Level Opioid Policies on Opioid-Related Mortality

Medicaid expansion and opioid deaths

The Affordable Care Act's Effects on Patients, Providers, and the Economy: What We've Learned So Far

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