Introduction
States’
decisions not to expand Medicaid under the Affordable Care Act (ACA) could
potentially affect access to care and health status among their low-income residents.
Methods
The
2010–2012 nationally representative Medical Expenditure Panel Survey data were
analyzed in 2015 to compare 9755 low-income adults aged 18–64 years from
Medicaid-expanding states with 7455 adults from nonexpanding states.
Multivariate logistic regression models were fitted to evaluate the differences
in access to care, receipt of preventive services, quality of care, attitudes
about health and self-reported health status by Medicaid expansion status. The
differences in care utilization and medical expenditures between the two groups
were examined using a 2-part modeling approach.
Results
Compared
to their counterparts in Medicaid expansion states, low income adults in the
nonexpanding states were more likely to be black and reside in rural areas and
were less likely to have a usual source of care (prevalence ratio[PR] 0.86, 95%
confidence interval[CI] 0.82–0.91) and recommended preventive services such as
dental checkups (PR = 0.86; CI = 0.79–0.94), routine checks (PR = 0.89; CI =
0.83–0.95), flu vaccinations (PR = 0.89; CI = 0.81–0.98), and blood pressure
checks (PR = 0.96; CI = 0.94–0.99). They also had less care utilization, fewer
prescriptions, and less medical expenditures, but more out-of-pocket
expenditures (all p-value <0.05).
Conclusions
Low-income adults in Medicaid nonexpanding states, who
are disproportionately represented by blacks and rural residents, were worse
off for multiple health-related outcomes compared to their counterparts in
Medicaid expanding states at the baseline of ACA implementation, suggesting
that low income adults residing in nonexpanding states may benefit markedly
from the expansion of Medicaid
Below: Number of care utilization and expenditures by Medicaid expansion status among low income population aged 18–64 years
Full article
at: http://goo.gl/KCUJBx
By:
Xuesong Han, Binh T. Nguyen, Jeffrey Drope, Ahmedin Jemal
Intramural Research, American Cancer Society, Atlanta,
Georgia, United States of America
Xuesong Han, Ahmedin Jemal
Rollins School of Public Health, Emory University, Atlanta,
Georgia, United States of America
More at: https://twitter.com/hiv
insight
No comments:
Post a Comment