The Affordable Care Act and implications for young adult health

Monaghan, Maureen

doi:10.1007/s13142-013-0245-9

Cited by 17 publications

(21 citation statements)

References 21 publications

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“…Young women are less likely to want a pregnancy at this stage in their lives [3], and may have less access to reproductive health care than their older counterparts [7]. At the same time, women in the South have less access to the full spectrum of reproductive health services than women in other parts of the country [8].…”

Section: Introductionmentioning

confidence: 99%

Norms and stigma regarding pregnancy decisions during an unintended pregnancy: Development and predictors of scales among young women in the U.S. South

et al. 2017

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BackgroundNorms and stigma regarding pregnancy decisions (parenting, adoption, and abortion) are salient to maternal well-being, particularly for groups disproportionately affected by unintended pregnancy. However, there are few validated measures of individual-level perceptions of norms and stigma around pregnancy decisions. Additionally, little is known about variation in the content of norms regarding pregnancy decisions, and in stigma related to violations of these norms, across socio-demographic groups.MethodsTo create measures of perceived norms and stigma around pregnancy decisions, we developed and pre-tested 97 survey items using a mixed methods approach. The resulting survey was administered to 642 young adult women recruited from health department clinics and a public university campus in Birmingham, Alabama. Principal components factor analyses, reliability analyses, independent t-tests, and correlation analyses were conducted to establish the reliability and validity of scales. Additionally, multiple linear regression was used to identify demographic predictors of higher scale scores.ResultsFactor analyses revealed four subscales for each pregnancy decision: conditional acceptability, anticipated reactions, stereotypes/misperceptions, and attitudes. The total scales and their subscales demonstrated good internal reliability (alpha coefficients 0.72–0.94). The mean scores for each scale were significantly associated with each other, with related measures, and differed by sociodemographic characteristics. Specifically, in adjusted analyses, women in the university setting and White women expressed more negative attitudes and stigma around parenting. Minority women endorsed more negative norms and stigma around adoption. Finally, women from the health department, White women, and religious women expressed more negative norms and stigma around abortion.ConclusionFindings suggest that our multidimensional measures have good psychometric properties in our sample of young women in the U.S. South, and highlight the importance of conceptualizing and measuring norms and stigmas around all pregnancy decisions. These scales may be of use in research on pregnancy decision-making and evaluation of stigma-reduction interventions.

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Section: Introductionmentioning

confidence: 99%

Norms and stigma regarding pregnancy decisions during an unintended pregnancy: Development and predictors of scales among young women in the U.S. South

et al. 2017

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“…26 Predictions of how subsequent provisions, including expansion of Medicaid eligibility to 133% of the federal poverty level, introduction of state health insurance exchanges, and provision of income-based tax subsidies, could affect trauma patients and the viability of trauma hospitals are contentiously mixed. [27][28][29][30][31][32] The objective of this study was to assess for observed changes in insurance coverage and rehabilitation use among young adult trauma patients associated with the ACA, including introduction of the DCP and Medicaid expansion/open enrollment. We considered possible differences between DCPeligible vs -ineligible patients and among stratified demographic and community subgroups.…”

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confidence: 99%

Implications of the Patient Protection and Affordable Care Act on Insurance Coverage and Rehabilitation Use Among Young Adult Trauma Patients

et al. 2016

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IMPORTANCE Trauma is the leading cause of death and disability among young adults, who are also among the most likely to be uninsured. Efforts to increase insurance coverage, including passage of the Patient Protection and Affordable Care Act (ACA), were intended to improve access to care and promote improvements in outcomes. However, despite reported gains in coverage, the ACA's success in promoting use of high-quality care and enacting changes in clinical end points remains unclear. OBJECTIVES To assess for observed changes in insurance coverage and rehabilitation use among young adult trauma patients associated with the ACA, including the Dependent Coverage Provision (DCP) and Medicaid expansion/open enrollment, and to consider possible insurance and rehabilitation differences between DCP-eligible vs-ineligible patients and among stratified demographic and community subgroups. DESIGN, SETTING, AND PARTICIPANTS A longitudinal assessment of DCP implementation and Medicaid expansion/open enrollment using risk-adjusted before-and-after, difference-indifference, and interrupted time-series analyses was conducted. Eleven years (January 1, 2005, to September 31, 2015) of Maryland Health Services Cost Review Commission data, representing complete patient records from all payers within the state, were used to identify all hospitalized young adult (aged 18-34 years) trauma patients in Maryland during the study period. RESULTS Of the 69 507 hospitalized patients included, 50 548 (72.7%) were male, and the mean (SD) age was 25 (5) years. Before implementation of the DCP, 1 of 4 patients was uninsured. After ACA implementation, the number fell to less than 1 of 10, with similar patterns emerging in emergency department and outpatient settings. The change was primarily driven by Medicaid expansion/open enrollment, which corresponded to a 20.1 percentage-point increase in Medicaid (95% CI, 18.9-21.3) and an 18.2 percentage-point decrease in uninsured (95% CI, −19.3 to −17.2). No changes were detected among privately insured patients. Rehabilitation use increased by 5.4 percentage points (95% CI, 4.5-6.2)-a 60% relative increase from a baseline of 9%. Mortality (−0.5; 95% CI, −0.9 to −0.1) and failure-to-rescue rates (−4.5; 95% CI, −7.4 to −1.6) also significantly declined. Stratified changes point to significant differences in the percentage of uninsured patients and rehabilitation access across the board, mitigating or even eradicating disparities in certain cases. CONCLUSIONS AND RELEVANCE For patients who are injured, young, and uninsured, Medicaid expansion/open enrollment in Maryland changed insurance coverage and altered patient outcomes in ways that the DCP alone was never intended to do. Implementation of Medicaid expansion/open enrollment transformed the landscape of trauma coverage, directly affecting the health of one of the country's most vulnerable at-risk groups.

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“… 29 In the United States, the Patient Protection and Affordable Care Act (ACA) since 2010 enables young adults to remain as dependents on their parents’ health insurance until age 26 and expands insurance coverage including mandatory coverage for preventive services with no copayment. 4 , 5 , 30 Many studies reported that the ACA provision significantly improved young adults’ access to and utilization of healthcare services and provided protection against overall out-of-pocket medical expenditures. 9 , 27 , 30 – 32 …”

Section: Discussionmentioning

confidence: 99%

Income Disparities in the Use of Health Screening Services Among University Students in Korea

Lee¹,

Joh²,

Kim

et al. 2016

Medicine

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The Affordable Care Act and implications for young adult health

Cited by 17 publications

References 21 publications

Norms and stigma regarding pregnancy decisions during an unintended pregnancy: Development and predictors of scales among young women in the U.S. South

Norms and stigma regarding pregnancy decisions during an unintended pregnancy: Development and predictors of scales among young women in the U.S. South

Implications of the Patient Protection and Affordable Care Act on Insurance Coverage and Rehabilitation Use Among Young Adult Trauma Patients

Income Disparities in the Use of Health Screening Services Among University Students in Korea

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