HEALTH INSURANCE STATUS AFFECTS ASTHMA OUTCOMES FOR THOSE ELIGIBLE FOR MEDICAID EXPANSION

Abstract

SESSION TITLE: Practice Management and Administration Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Asthma has disproportionately affected individuals from lower socioeconomic status. The Affordable Care Act expanded Medicaid for individuals up to 138% of the federal poverty level (FPL) with the hope that it would improve health outcomes. There is limited research available on the effects of insurance status on asthma outcomes when specifically evaluating this population. Furthermore, there is no available research on the effects of Medicaid expansion on asthma outcomes. METHODS: This is a pooled cross sectional observational study using the NHIS data from 2011-2013 and 2016-2018. 2014 and 2015 were omitted to allow for a ACA implementation washout period. Given the data construction, individuals <149% of the FPL with a history of asthma and aged 18-64 were identified. The dependent variable is a binary outcome of asthma control defined as having an exacerbation or requiring an ER visit or in-patient hospitalization in the past year. A survey weighted logistic regression model was used to evaluate the association between insurance status and asthma control. Proposed mediators of cost barriers to physicians and medications were tested using the KHB model. Lastly, a logistic regression model was used to evaluate the association of post ACA implementation years on asthma control. RESULTS: The NHIS data resulted in 4,164 observations. Descriptive analysis showed 43.5% asthma control for uninsured vs 46.2% for insured. Individuals with cost barriers for physician visits had 38.5% asthma control vs 50% with no barrier. Similarly, individuals with medication barriers had 33% asthma control vs 51% without barriers. Cost barrier to physician and medication both independently demonstrated complete mediation. Having health insurance had an OR of 1.23 (p<0.05) for asthma control. Adding mediators individually for cost barriers to physician (OR 1.43, p<0.05) and medications (OR 1.86, p<0.05) removes the association of insurance status and asthma control. Post ACA, the uninsured rate fell from 25% to 12%. The post ACA time period had an OR of 1.16 (p=0.09) for asthma control. The magnitude of effect of the ACA on having insurance (OR 2.4) is significantly greater than the effect on reducing cost barrier to physicians (OR 1.8) and medications (OR 1.6). CONCLUSIONS: Having insurance is associated with better asthma control. This relationship is mediated by the cost of accessing care. The magnitude of the association of insurance status on asthma is not as strong as the association of cost barriers on asthma. A possible explanation is under insurance where individuals have insurance but still have financial barriers to accessing care. CLINICAL IMPLICATIONS: Medicaid expansion resulted in a significant decrease in the uninsured. However, the policy did not have the same magnitude of effect on reducing cost barriers. The continued cost barriers may explain the lack of population level improvement in asthma control. DISCLOSURES: No relevant relationships by Jack Needleman, source=Web Response No relevant relationships by Rajat Suri, source=Web Response