The Role of the Medicaid Expansion in the Use of Preventive Health Care Services in California Men

Abstract

Men’s use of preventive care services may be constrained due to a number of factors including lack of health care insurance. California used the Medicaid expansion provisions of the Affordable Care Act (ACA) to enroll low-income men between the ages of 18 and 64 years in publicly funded health insurance. Most studies on the effect of the ACA on health care services have focused on racial/ethnic differences rather than gender. Data from the California Health Interview Survey for the 2015–2016 survey period were used to model the use of preventive health care services in the year prior to interview. Population weights were used in the analysis which was done using PROC SURVEY LOGISTIC in SAS software, version 9.4. The sample consisted of men between the ages of 18 and 64 years ( N = 6,180). Of these 66% ( n = 4,088) reporting receiving any preventive care services in the year prior to interview. The largest proportions of respondents fell into the youngest group aged 18–25 (17%) followed by the oldest group aged 60–64 (16.9%); 43% reported they were married, 57% had incomes at greater than 300% of the federal poverty level. There was no effect of race or ethnicity on receiving preventive care services. Having a chronic condition such as hypertension or diabetes was associated with a greater odds of receiving preventive care. Expanding Medicaid to include low-income men below the age of 65 is associated with increased use of preventive health care, especially among those with chronic conditions.

Associations of Medicaid Expansion With Insurance Coverage, Stage at Diagnosis, and Treatment Among Patients With Genitourinary Malignant Neoplasms

“…This study has some limitations. One potential limitation of this study is the geographic variability in the proportion of cancer cases captured in the NCDB . Furthermore, Commission on Cancer–accredited hospitals are more likely to be larger, academic, urban facilities that offer more cancer-related services, such as screening, chemotherapy, and radiation .…”

“… 61 , 62 , 63 , 64 , 65 In the years surrounding Medicaid expansion, the incidence of kidney cancer in the US was relatively unchanged. However, studies have shown that the Medicaid expansion was associated with increased preventive care visits 66 and increased outpatient visits. 67 Thus, there is a similar potential explanation wherein the increased access to care and resources afforded by Medicaid expansion may lead to increased incidental diagnosis at early stages when kidney cancer is still asymptomatic.…”

“…One potential limitation of this study is the geographic variability in the proportion of cancer cases captured in the NCDB. 66 Furthermore, Commission on Cancer–accredited hospitals are more likely to be larger, academic, urban facilities that offer more cancer-related services, such as screening, chemotherapy, and radiation. 68 However, previous analyses, such as a 2018 study by Eguia et al, 27 have reported that most demographic and clinical characteristics are remarkably similar between the NCDB and the population-based Surveillance, Epidemiology, and End Results database.…”

The Effect of Race and Other Factors on the Utilization of Annual Physical Examinations and Preventive Healthcare Services in the District of Columbia

“…Some of the preventive services covered under the ACA are blood pressure, diabetes, cholesterol tests, colorectal cancer screening, depression screening, HIV screening, diet counseling, and hepatitis B and C screening (Fox & Shaw, 2015). The ACA also provides for preventive care services without cost-sharing under Medicare and requires that states cover preventive services under Medicaid without any cost-sharing (Reynolds & Fisher, 2020).…”