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1.
Front Public Health ; 9: 707907, 2021.
Article in English | MEDLINE | ID: covidwho-1775824

ABSTRACT

Objectives: To investigate the association of state-level Medicaid expansion and non-elderly mortality rates from 1999 to 2018 in Northeastern urban settings. Methods: This quasi-experimental study utilized a synthetic control method to assess the association of Medicaid expansion on non-elderly urban mortality rates [1999-2018]. Counties encompassing the largest cities in the Northeastern Megalopolis (Washington D.C., Baltimore, Philadelphia, New York City, and Boston) were selected as treatment units (n = 5 cities, 3,543,302 individuals in 2018). Cities in states without Medicaid expansion were utilized as control units (n = 17 cities, 12,713,768 individuals in 2018). Results: Across all cities, there was a significant reduction in the neoplasm (Population-Adjusted Average Treatment Effect = -1.37 [95% CI -2.73, -0.42]) and all-cause (Population-Adjusted Average Treatment Effect = -2.57 [95%CI -8.46, -0.58]) mortality rate. Washington D.C. encountered the largest reductions in mortality (Average Treatment Effect on All-Cause Medical Mortality = -5.40 monthly deaths per 100,000 individuals [95% CI -12.50, -3.34], -18.84% [95% CI -43.64%, -11.67%] reduction, p = < 0.001; Average Treatment Effect on Neoplasm Mortality = -1.95 monthly deaths per 100,000 individuals [95% CI -3.04, -0.98], -21.88% [95% CI -34.10%, -10.99%] reduction, p = 0.002). Reductions in all-cause medical mortality and neoplasm mortality rates were similarly observed in other cities. Conclusion: Significant reductions in urban mortality rates were associated with Medicaid expansion. Our study suggests that Medicaid expansion saved lives in the observed urban settings.


Subject(s)
Medicaid , Mortality , Urban Population , Humans , Middle Aged , Neoplasms , Patient Protection and Affordable Care Act , United States/epidemiology , Washington
2.
Health Aff (Millwood) ; 41(3): 322-323, 2022 03.
Article in English | MEDLINE | ID: covidwho-1742027

ABSTRACT

Marketplace enrollment rose significantly, and the Biden administration proposed sweeping new standards for 2023.


Subject(s)
Insurance Coverage , Patient Protection and Affordable Care Act , Humans , Reference Standards , United States
3.
Health Aff (Millwood) ; 41(3): 390-397, 2022 03.
Article in English | MEDLINE | ID: covidwho-1742025

ABSTRACT

The Affordable Care Act (ACA) Marketplace plays a critical role in providing affordable health insurance for the nongroup market, yet the accessibility of plans from insurers with high quality ratings has not been investigated. Our analysis of recently released insurer quality star ratings for plan year 2020 found substantial variation in access to high rated plans in the federally facilitated ACA Marketplace. In most participating counties (1,390 of 2,265, or 61.4 percent), the highest-rated ACA Marketplace insurer had a three-star rating. Fewer than one-third of counties (703, or 31.0 percent) had access to four- or five-star-rated insurers. Fewer than 10 percent (172, or 7.6 percent) had access to only one- or two-star-rated insurers. In plan-based analyses, each one-point increase in star rating was associated with a $28 increase in the average monthly plan premium. Counties with the highest proportion of residents obtaining individual coverage through the ACA Marketplace and counties with more insurers were the most likely to have access to plans from high-rated insurers. We found no systematic racial or ethnic disparities in access to plans from high-rated insurers. Policy makers should continue to monitor the quality of available health plans.


Subject(s)
Health Insurance Exchanges , Patient Protection and Affordable Care Act , Humans , Insurance Carriers , Insurance Coverage , Insurance, Health , United States
5.
J Health Polit Policy Law ; 47(1): 1-25, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1604881

ABSTRACT

CONTEXT: The United States is the only high-income country that relies on employer-sponsored health coverage to insure a majority of its population. Millions of Americans lost employer-sponsored health insurance during the COVID-19-induced economic downturn. We examine public opinion toward universal health coverage policies in this context. METHODS: Through a survey of 1,211 Americans in June 2020, we examine the influence of health insurance loss on support for Medicare for All (M4A) and the Affordable Care Act (ACA) in two ways. First, we examine associations between pandemic-related health insurance loss and M4A support. Second, we experimentally prime some respondents with a vignette of a sympathetic person who lost employer-sponsored coverage during COVID-19. FINDINGS: We find that directly experiencing recent health insurance loss is strongly associated (10 pp, p < 0.01) with greater M4A support and with more favorable views of extending the ACA (19.3 pp, p < 0.01). Experimental exposure to the vignette increases M4A support by 6 pp (p = 0.05). CONCLUSIONS: In the context of the COVID-19 pandemic, situational framings can induce modest change in support for M4A. However, real-world health insurance losses are associated with larger differences in support for M4A and with greater support for existing safety net policies such as the ACA.


Subject(s)
COVID-19 , Health Policy , Humans , Insurance Coverage , Insurance, Health , Medicare , Pandemics , Patient Protection and Affordable Care Act , SARS-CoV-2 , State Medicine , United States , Universal Health Insurance
6.
Obstet Gynecol ; 139(2): 269-276, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1608113

ABSTRACT

OBJECTIVE: To synthesize the empirical research evidence about the association between Medicaid expansion under the Affordable Care Act (ACA) and increasing perinatal care access and utilization among low-income women. DATA SOURCES: We searched MEDLINE through PubMed (1966-present), EMBASE (Ovid), the Cumulative Index to Nursing and Allied Health (1982-present), PAIS Index (ProQuest), Web of Science (1900-present), and the Cochrane Central Register of Controlled Trials. Our review focuses on the association between Medicaid expansion under the ACA and perinatal care access and utilization, which cannot be subjected to randomized controlled trials, therefore ClinicalTrials.gov was not included in our search. METHODS OF STUDY SELECTION: A comprehensive search of the research literature was performed using Covidence. Studies were eligible if they were based on population data and research designs ensuring that the exposure (ie, Medicaid expansion under the ACA) preceded the perinatal care access or utilization outcome, had an appropriate comparison group, presented quantitative data, and examined pregnant or postpartum women. The search in six bibliographic databases returned 1,243 records, with 855 abstracts reviewed, 34 full-text articles screened for eligibility, and nine eligible studies included in the systematic review. TABULATION, INTEGRATION, AND RESULTS: Stata 16 software was used to generate summary estimates, forest plots, funnel plots, and heterogeneity statistics. Random effects modeling based on pooled data revealed that Medicaid expansion was associated with a 6.1% increase in Medicaid enrollment for pregnant women (95% CI 1.3-10.9%) and a 3.3% increase in perinatal care utilization (95% CI 0.2-6.3%). CONCLUSION: Medicaid expansion under the ACA is associated with a modest and statistically significant increase in perinatal care access and utilization among low-income women.


Subject(s)
Health Services Accessibility , Medicaid , Patient Protection and Affordable Care Act , Perinatal Care , Female , Humans , Pregnancy , United States
7.
Health Aff (Millwood) ; 41(1): 13-25, 2022 01.
Article in English | MEDLINE | ID: covidwho-1574499

ABSTRACT

US health care spending increased 9.7 percent to reach $4.1 trillion in 2020, a much faster rate than the 4.3 percent increase seen in 2019. The acceleration in 2020 was due to a 36.0 percent increase in federal expenditures for health care that occurred largely in response to the COVID-19 pandemic. At the same time, gross domestic product declined 2.2 percent, and the share of the economy devoted to health care spending spiked, reaching 19.7 percent. In 2020 the number of uninsured people fell, while at the same time there were significant shifts in types of coverage.


Subject(s)
COVID-19 , Health Expenditures , Delivery of Health Care , Humans , Insurance, Health , Medicare , Pandemics/prevention & control , Patient Protection and Affordable Care Act , SARS-CoV-2 , United States
8.
Prev Med ; 154: 106901, 2022 01.
Article in English | MEDLINE | ID: covidwho-1541025

ABSTRACT

The Health Insurance Marketplace has offered access to private health insurance coverage for over 10 million Americans, including previously uninsured women. Per Affordable Care Act requirements, Marketplace plans must cover preventive services without patient cost-sharing in the same way as in employer-sponsored insurance (ESI). However, no study has evaluated whether the utilization of preventive services is similar between Marketplace enrollees and ESI enrollees. Using the Medical Expenditure Panel Survey data for 2014-2016, we identified working-age women with Marketplace plans (n = 792, N = 2,567,292) and ESI (n = 13,100, N = 52,557,779). We compared the two groups' receipt rates of five evidence-based preventive services: blood pressure screening, influenza vaccine, Pap test, mammogram, and colorectal cancer screening. Unadjusted results showed marketplace enrolled women had significantly lower odds of influenza vaccination, Pap test, and mammogram. However, after controlling for other factors, Marketplace insurance was not associated with lower receipt rates of preventive services, except for influenza vaccination (Adjusted OR = 0.64; 95% CI = 0.50-0.82). Regardless of an individual's private insurance type, higher educational attainment and having a usual source of medical care showed the strongest association with the receipt of all investigated preventive services. With the increased role of the Marketplace as a safety net in the COVID-19 pandemic, more research and outreach efforts should be made to facilitate access to preventive services for its enrollees.


Subject(s)
COVID-19 , Health Insurance Exchanges , Female , Health Services Accessibility , Humans , Insurance Coverage , Insurance, Health , Pandemics , Patient Protection and Affordable Care Act , Preventive Health Services , SARS-CoV-2 , United States
9.
Lancet ; 397(10279): 1127-1138, 2021 03 20.
Article in English | MEDLINE | ID: covidwho-1525996

ABSTRACT

In 2010, the US health insurance system underwent one of its most substantial transformations with the passage of the Affordable Care Act, which increased coverage for millions of people in the USA, including those with and at risk of HIV. Even so, the system of HIV care and prevention services in the USA is a complex patchwork of payers, providers, and financing mechanisms. People with HIV are primarily covered by Medicaid, Medicare, private insurance, or a combination of these; many get care through other programmes, particularly the Ryan White HIV/AIDS Program, which serves as the nation's safety net for people with HIV who remain uninsured or underinsured but offers modest to no support for prevention services. While uninsurance has drastically declined over the past decade, the USA trails other high-income countries in key HIV-specific metrics, including rates of viral suppression. In this paper in the Series, we provide an overview of the coverage and financing landscape for HIV treatment and prevention in the USA, discuss how the Affordable Care Act has changed the domestic health-care system, examine the major programmes that provide coverage and services, and identify remaining challenges.


Subject(s)
Acquired Immunodeficiency Syndrome/epidemiology , COVID-19/economics , HIV Infections/drug therapy , HIV Infections/prevention & control , Insurance Coverage/legislation & jurisprudence , Insurance, Health/legislation & jurisprudence , Acquired Immunodeficiency Syndrome/drug therapy , Adult , Aged , Anti-Retroviral Agents/therapeutic use , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Female , Gender Identity , HIV Infections/economics , HIV Infections/epidemiology , Humans , Incidence , Male , Medicaid/statistics & numerical data , Medically Uninsured/statistics & numerical data , Medicare/statistics & numerical data , Middle Aged , Patient Protection and Affordable Care Act , Risk Assessment , SARS-CoV-2/genetics , United States/epidemiology
10.
Thorac Surg Clin ; 32(1): 13-21, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1517484

ABSTRACT

Racial disparities in health care systems exist in all phases of health care delivery. The Affordable Care Act has been unable to completely mitigate disparities in health care as the root cause (ie, socioeconomic inequality) remains unaddressed. Uninsured status, lack of transportation, high costs, health literacy, provider unavailability, lack of trust in the health system, and implicit bias block minority populations from obtaining deserved quality care. With the COVID-19 crisis, increased sensitivity and development of innovative approaches to provide accessibly and quality health care are necessary.


Subject(s)
COVID-19 , Patient Protection and Affordable Care Act , Delivery of Health Care , Humans , Quality of Health Care , SARS-CoV-2 , United States
11.
Health Aff (Millwood) ; 40(11): 1679, 2021 11.
Article in English | MEDLINE | ID: covidwho-1502084
12.
Health Aff (Millwood) ; 40(11): 1680-1681, 2021 11.
Article in English | MEDLINE | ID: covidwho-1502083

ABSTRACT

The Affordable Care Act served as a pandemic safety net. Congress and the White House aim to further expand the law.


Subject(s)
Insurance Coverage , Patient Protection and Affordable Care Act , Humans , Insurance, Health , Medicaid , United States
13.
Health Aff (Millwood) ; 40(11): 1713-1721, 2021 11.
Article in English | MEDLINE | ID: covidwho-1502079

ABSTRACT

The Affordable Care Act provides tax credits for Marketplace insurance, but before 2021, families with incomes above four times the federal poverty level did not qualify for tax credits and could face substantial financial burdens when purchasing coverage. As a measure of affordability, we calculated potential Marketplace premiums as a percentage of family income among families with incomes of 401-600 percent of poverty. In 2015 half of this middle-class population would have paid at least 7.7 percent of their income for the lowest-cost bronze plan; in 2019 they would have paid at least 11.3 percent of their income. By 2019 half of the near-elderly ages 55-64 would have paid at least 18.9 percent of their income for the lowest-cost bronze plan in their area. The American Rescue Plan Act temporarily expanded tax credit eligibility for 2021 and 2022, but our results suggest that families with incomes of 401-600 percent of poverty will again face substantial financial burdens after the temporary subsidies expire.


Subject(s)
Health Insurance Exchanges , Patient Protection and Affordable Care Act , Aged , Costs and Cost Analysis , Eligibility Determination , Humans , Insurance Coverage , Insurance, Health , Middle Aged , United States
14.
Health Aff (Millwood) ; 40(11): 1722-1730, 2021 11.
Article in English | MEDLINE | ID: covidwho-1496546

ABSTRACT

In 2020 the COVID-19 pandemic caused millions to lose their jobs and, consequently, their employer-sponsored health insurance. Enacted in 2010, the Affordable Care Act (ACA) created safeguards for such events by expanding Medicaid coverage and establishing Marketplaces through which people could purchase health insurance. Using a novel national data set with information on ACA-compliant individual insurance plans, we found large increases in Marketplace enrollment in 2020 compared with 2019 but with varying percentage increases and spending risk implications across states. States that did not expand Medicaid had enrollment and spending risk increases. States that expanded Medicaid but did not relax 2020 Marketplace enrollment criteria also had spending risk increases. In contrast, states that expanded Medicaid and relaxed 2020 enrollment criteria experienced enrollment increases without spending risk changes. The findings are reassuring with respect to the ability of Marketplaces to buffer employment shocks, but they also provide cautionary signals that risks and premiums could begin to rise either in the absence of Medicaid expansion or when Marketplace enrollment is constrained.


Subject(s)
COVID-19 , Health Insurance Exchanges , Humans , Insurance Coverage , Insurance, Health , Medicaid , Pandemics , Patient Protection and Affordable Care Act , SARS-CoV-2 , United States
16.
Milbank Q ; 100(1): 11-37, 2022 03.
Article in English | MEDLINE | ID: covidwho-1462704

ABSTRACT

Policy Points Twelve states have yet to expand Medicaid under the Affordable Care Act (ACA). Louisiana offers a model of steps that states and counties can take to rapidly enroll eligible persons while balancing eligibility integrity and doing so within a limited administrative budget. In a post-COVID-19 health care landscape, Medicaid expansion can improve and protect population health and boost state economies, even amid budget shortfalls. Even though Louisiana compares well with other states in eligibility and enrollment efforts, future expansions may integrate other social support programs into their implementation strategies.


Subject(s)
COVID-19 , Medicaid , Eligibility Determination , Humans , Insurance Coverage , Louisiana , Patient Protection and Affordable Care Act , United States
17.
Health Aff (Millwood) ; 40(10): 1637-1643, 2021 10.
Article in English | MEDLINE | ID: covidwho-1456099

ABSTRACT

Addressing health inequities for racial and ethnic minority populations is challenging. After passage of the Affordable Care Act, Michigan launched its Healthy Michigan Plan, which expanded Medicaid eligibility in the state. Our evaluation of the expansion provided the opportunity to study its impact on racial and ethnic minority groups, including Arab American and Chaldean American enrollees, an understudied population. Using data from telephone surveys collected in 2016, 2017, and 2018, we conducted an analysis to study the plan's impact on access to a regular source of care and health status among racial and ethnic minority groups. More than 90 percent of respondents of all racial and ethnic groups reported having a regular source of care after plan enrollment compared with 74.4 percent before enrollment. Respondents who identified as non-Hispanic White, African American, and Hispanic reported improvements in health status after plan enrollment. Our study demonstrates the potential of health insurance access to narrow health inequities between racial and ethnic groups.


Subject(s)
Medicaid , Health Services Accessibility , Health Status , Humans , Michigan , Minority Groups , Patient Protection and Affordable Care Act , Self Report , United States
19.
Gastrointest Endosc Clin N Am ; 31(4): 727-742, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1427945

ABSTRACT

Quality metrics and standardization has become critical as the Affordable Care Act mandates that the Center for Medicare and Medicaid Services change reimbursement from volume to a value-based system. While the most commonly used quality indicators are related to that of colonoscopy, quality metrics for other procedures and endoscopy units have been developed mainly by the American College of Gastroenterology and the American Society of Gastrointestinal Endoscopy. Data to show that these quality metrics, especially in the field of advanced endoscopy as well as in the era of COVID-19 pandemic, can improve patient outcomes, are anticipated.


Subject(s)
Benchmarking , COVID-19 , Aged , Colonoscopy , Humans , Medicare , Pandemics , Patient Protection and Affordable Care Act , Reference Standards , SARS-CoV-2 , United States
20.
Health Aff (Millwood) ; 40(9): 1352-1353, 2021 09.
Article in English | MEDLINE | ID: covidwho-1412759

ABSTRACT

The Affordable Care Act survives another legal challenge; the Biden administration is overseeing expansions of the law.


Subject(s)
Patient Protection and Affordable Care Act , Humans , United States
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