Wisconsin Experience Indicates That Expanding Public Insurance To Low-Income Childless Adults Has Health Care Impacts

DeLeire, Thomas; Dague, Laura; Leininger, Lindsey; Voskuil, Kristen; Friedsam, Donna

doi:10.1377/hlthaff.2012.1026

Cited by 73 publications

(78 citation statements)

References 21 publications

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“…Our results corroborate, on a national level, trends that have been observed in several states (Oregon, 8 Wisconsin, 9 and Massachusetts 10 ) when they expanded Medicaid coverage; that is, expanded Medicaid coverage is associated with increased ED usage. This seems counterintuitive, but there are many opposing issues involved.…”

Section: Discussionsupporting

confidence: 88%

Changes in Insurance Status and Emergency Department Visits After the 2008 Economic Downturn

Watts

Bryan

Tarwater

2014

Academic Emergency Medicine

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Objectives: As the U.S. economy began its downward trend in 2008, many citizens lost their jobs and, ultimately, their employer-sponsored health care insurance. The expectation was that many of the newly uninsured would turn to emergency departments (EDs) for their health care. This study was undertaken to determine, first, if changes in the insurance status of the general population were reflected in the ED insurance payer mix and, second, whether there was evidence of an increased reliance on the ED as a continuing source of health care for any payer group(s).Methods: This was a retrospective observational study using public data files from the National Hospital Ambulatory Medical Care Survey for Emergency Departments for years 2006 through 2010 (2008 AE 2 years). Changes in the relative proportions of ED visits funded annually by private insurance, Medicaid, Medicare, and self-pay (uninsured) were analyzed using a logistic model. Poisson regression was used to compare trends in the rates of ED visits for each payer type (i.e., number of ED visits per 100 persons with each insurance type). A linear spline term was used to determine if there was a change in each risk estimate after 2008 compared to the risk estimate before 2008. The growth in Medicaid-funded ED visits was attributable to increased numbers of visits by both pediatric (<18 years old) and non-elderly adult (19 to 64 years old) patients. For both Medicaid and private insurance visits, the change in trend in 2008 was statistically significant (p < 0.001 and p = 0.004, respectively). Self-pay visits were fairly steady before 2008 and then increased by about 5% per year after 2008, but this was not statistically significant (OR = 1.05, 95% CI = 0.96 to 1.14; p = 0.46), nor was the change in trend (p = 0.29). The results for Medicare-funded visits were also small and not statistically significant. There was also evidence of increased reliance on the ED by Medicaid-funded patients based on the comparison of ED visit rates. After 2008, the incidence rate ratio (IRR) for Medicaid-funded visits increased by 10% per year (IRR = 1.10, 95% CI = 1.10 to 1.10; p < 0.001) while the IRR for the other three payer groups changed about 1% per year (IRR = 0.99, 95% CI = 0.99 to 0.099; p < 0.001), indicating an increasing utilization of the ED by patients with Medicaid-funded care.Conclusions: After 2008, Medicaid patients were more dependent on ED services than uninsured, Medicare, or privately insured patients. Medicaid patients made up an increasing proportion of ED patients, and the rate of usage of ED services by all ages of Medicaid patients was significantly greater than that of the other three payer groups.ACADEMIC EMERGENCY MEDICINE 2015;22:73-80

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Section: Discussionsupporting

confidence: 88%

Changes in Insurance Status and Emergency Department Visits After the 2008 Economic Downturn

Watts

Bryan

Tarwater

2014

Academic Emergency Medicine

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“…One question raised by our results was why we did not also find a significant improvement in access to care associated with the early expansion in California, given previous evidence from quasi-experimental and randomized trials that found Medicaid expansions were associated with improved access to care (6, 7, 15). There are several possible explanations.…”

Section: Discussionmentioning

confidence: 53%

California’s Early ACA Expansion Increased Coverage And Reduced Out-Of-Pocket Spending For The State’s Low-Income Population

2015

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The Affordable Care Act has expanded Medicaid to millions of low-income adults since the law first went into effect. While many states implemented the Medicaid expansion since 2014, five states and the District of Columbia took advantage of provisions in the ACA and Medicaid waivers that allowed them to expand public coverage as early as 2010. We examined the impact of California's Low-Income Health Program that began in 2010, using restricted data from the National Health Interview Survey. Our study demonstrates that the county-by-county roll out of expanded eligibility for public insurance in California increased coverage by 7 percentage points (p < 0.05) and reduced the likelihood of any family out-of-pocket medical spending in the past year by 10 percentage points (p < 0.05) among low-income adults.

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“…This complementary relationship between outpatient and ED care use is not a unique finding within publicly insured populations that experience expanded insurance coverage. (47, 48) Increased use of the ED may result from greater access to outpatient clinicians that refer patients to emergency care for acute events.…”

Section: Discussionmentioning

confidence: 99%

The Effects of the Transition From Medicaid to Medicare on Health Care Use for Adults With Mental Illness

et al. 2016

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Background The transition from Medicaid-only to dual Medicare/Medicaid coverage has the potential to reduce financial barriers to health care for patients with serious mental illness (SMI) through increased coverage or expanded access to clinicians as their reimbursement increases. Aims To estimate the effect of dual coverage after Medicaid enrollment during the required waiting period among adults with SMI on health care use, overall and related to mental health and substance use disorders (MHSUD). Methods Data include enrollment and claims from Medicaid and Medicare in Missouri (MO) and South Carolina (SC), from January 2004 – December 2007. We used an interrupted time series design to estimate the effect of dual coverage on average use of outpatient, emergency (ED), and inpatient care/month. Results After 12-months of dual coverage, the probability of outpatient care use increased in both states from 4 – 9%. In MO the mean probability and frequency of ED visits, total and MHSUD-related, increased by 21–32%; the probability of all-cause and MHSUD-related inpatient admissions increased by 10% and 19% respectively. In SC, the mean probability of any inpatient admission increased by 27% and of any MHSUD-related inpatient admission by 42%. Discussion The increase in use of outpatient care is consistent with the expected increase in coverage of, and payment for, outpatient services under dual coverage relative to Medicaid-only. Sustained increases in ED and inpatient admissions raise questions regarding the complexity of obtaining care under 2 programs, pent-up demand among beneficiaries pre-transition, and the complementarity of outpatient and inpatient service use.

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Wisconsin Experience Indicates That Expanding Public Insurance To Low-Income Childless Adults Has Health Care Impacts

Cited by 73 publications

References 21 publications

Changes in Insurance Status and Emergency Department Visits After the 2008 Economic Downturn

Changes in Insurance Status and Emergency Department Visits After the 2008 Economic Downturn

California’s Early ACA Expansion Increased Coverage And Reduced Out-Of-Pocket Spending For The State’s Low-Income Population

The Effects of the Transition From Medicaid to Medicare on Health Care Use for Adults With Mental Illness

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