Impact Of Affordable Care Act Research Articles

"Legislative Impact and Persistent Disparities: Post-Mastectomy Breast Reconstruction Rates in the United States Among 224,506 Patients".

Breast reconstruction following mastectomy for the treatment of breast cancer restores form and enhances patient satisfaction. The Affordable Care Act (ACA) of 2010 aimed to impact trends in breast reconstruction, but recent information regarding racial and ethnic disparities is lacking. We analyzed National Surgical Quality Improvement Program (NSQIP) data spanning 2005-2022 to investigate the impact of ACA on racial and ethnic diversity in immediate breast reconstruction post-mastectomy. Patient demographics, including race and ethnicity, were considered. Statistical analyses included Pearson chi-square tests and multivariable logistic regressions to assess trends and disparities over time. In total, 224,506 patients met inclusion criteria. Analysis revealed that in the pre-ACA era, American Indian or Alaska Native, Asian, and Black or African American individuals underwent immediate breast reconstruction at lower rates compared to White patients (P < 0.001). Additionally, Hispanic patients were less likely to undergo breast reconstruction compared to non-Hispanic patients (28.0% vs 33.4%; P < 0.001). In the post-ACA period, this trend persisted with all racial groups undergoing immediate breast reconstruction at lower rates compared to White patients (P < 0.001). However, Hispanic patients were more likely to undergo immediate breast reconstruction compared to non-Hispanic patients (53.8% vs 47.9%, P < 0.001). Despite legislative efforts and a steady increase in immediate breast reconstruction rates over the years, racial disparities in breast reconstruction rates persist, highlighting the need for ongoing monitoring and targeted interventions to ensure equitable reconstructive care for all patients.

Abstract A134: The impact of the Affordable Care Act on the colorectal cancer landscape in Louisiana

Abstract Louisiana (LA) is the only state in the deep south opting to expand Medicaid. This, along with the federal tax subsidies for low income individual to buy insurance on the health marketplace, facilitated health care access to medically underserved populations in LA. This study examines the differences in sociodemographic characteristics of those diagnosed with colorectal cancer (CRC) before and after the Patient Protection and Affordable Care Act (ACA) was implemented in LA, highlighting differences in receipt of timely CRC treatment and survival rates. Patient demographics, cancer treatment, and outcomes data were obtained from the Louisiana Tumor Registry and the sample population included adults diagnosed with CRC. Pre-ACA was defined from 1/2012-6/30/2016 and the post-ACA was 7/1/2016- 12/31/2020. Variables examined were age, race, sex, poverty, socioeconomic status, insurance, marital status, distance to urban center, stage of diagnosis, number of tumors, type and date of any treatment received. Descriptive analysis summarized sociodemographic and cancer diagnosis variables for the sample across the two time periods. Logistic regression analysis was used to examine the impact of ACA and Kaplan-Meier plots and cox regression analysis was used to examine the impact of ACA on survival rates. 20,497 people were diagnosed with CRC during the study time period (pre-ACA 10,044 vs post-ACA 10,453) and there were significant differences noted with age, marital status, poverty, SES, insurance, and all cancer diagnosis variables. The number of uninsured dropped by two-thirds (6% vs 2%, &amp;lt;0.001) while the number of those on Medicaid increased (6.5% vs 14%, &amp;lt;0.001). There were no significant differences in diagnosis by race in the overall sample however, among the Medicaid population, pre-ACA, 57% of those diagnosed were Black vs 40% who were White. Post-ACA, 50% of those diagnosed were Black vs 46% White. The percentage of patients diagnosed at Stage I increased post-ACA by 1% while the percentage of patients diagnosed at Stage III decreased by 2% (&amp;lt;0.0001). The percentage of those diagnosed without tumors increased from 74% pre-ACA to 78% post-ACA. The number of those who received chemotherapy and radiation also increased pre vs post-ACA. Regression models showed significant impact of ACA on stage of diagnosis, receipt of timely treatment, and uninsured rates. There were no significant differences in survival time across the two time periods, however, separated by insurance status, the Medicaid and private insurance populations saw significant improvements in survival time post-ACA. Expanded Medicaid coverage through Healthy LA began in the summer of 2016. Since then, more than 732,000 individuals have benefited from Medicaid expansion coverage and 92,607 have received federal subsidies. The results of this study present evidence to other southern states on the advantages of Medicaid expansion in cancer treatment and survival. Citation Format: Bilikisu Elewonibi, Malesa Pereira, Yaqi Zou. The impact of the Affordable Care Act on the colorectal cancer landscape in Louisiana [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A134.

Impact of the Affordable Care Act and Medicaid Expansion on Insurance Coverage and Outcomes in Patients with HIV‐associated Aggressive B‐cell Non‐Hodgkin Lymphomas

Introduction: HIV-associated lymphomas affect a uniquely disadvantaged group of patients, who were often denied insurance based on preexisting conditions until the Affordable Care Act (ACA) was signed in 2010. We investigated the impact of ACA and its Medicaid expansion in 2014 which covered the low-income strata, on outcomes among patients with HIV-associated aggressive B-cell non-Hodgkin lymphomas (HIV-aB-NHL). Methods: We used the National cancer database (NCDB) to identify HIV-associated aB-NHL patients aged 18–64 years from 2004 to 2017. We defined the pre-ACA period up to 2013 and the post-ACA period after 2014. States were grouped as Medicaid expansion adopted or not adopted. To reduce bias from advancements in anti-retroviral and chemo-immuno-therapies, we compared survival outcomes between 2010 to 2013 and 2014 to 2017. Kaplan-Meier method and a parametric Weibull model were used for survival analysis. Results: We identified 10,795 eligible patients with HIV-associated aB-NHL, comprised of 1802 Hispanics (16.7%), 3915 non-Hispanic blacks [NHB (36.3%)], 4727 Non-Hispanic Whites [NHW (43.8%)] and 351 other minorities (3.2%). The predominant diagnoses were diffuse large B-cell lymphoma (63.3%) and Burkitt lymphoma (20.1%). The figure shows the distribution of insurance status at diagnosis in Medicaid expansion (n = 4611) and non-expansion (n = 3091) states before and after the implementation of ACA stratified by race. Hispanics were more likely to be from residential zip codes in the lower educational quartile. A higher proportion of patients were seen at academic medical centers in expansion states across all races, and this further improved post-ACA. There was a significant improvement in survival seen among NHB (p < 0.01) post-ACA though the trend in Hispanics was not significant (P = 0.36). A multivariable survival analysis using the Weibull model adjusting for age, sex, insurance status, Charlson-Deyo comorbidity index, income, race, and Medicaid expansion status found statistically significant improvement in the states that adopted Medicaid expansion (HR 0.88, p < 0.01) though NHB race predicted poor survival (HR 1.49, p < 0.01). Keywords: Aggressive B-cell non-Hodgkin lymphoma, Cancer Health Disparities Conflicts of interests pertinent to the abstract. L. D. Anderson Consultant or advisory role: Celgene, BMS, Amgen, GSK, Janssen, Karyopharm, Beigene, AbbVie, Cellectar, and Sanofi Y. F. Madanat Consultant or advisory role: BluePrint Medicines, GERON, OncLive, Sierra Oncology, Stemline Therapeutics and Novartis G. Kaur Honoraria: BMS and Cellectar F. T. Awan Consultant or advisory role: Genentech, Astrazeneca, Abbvie, Janssen, Pharmacyclics, Gilead sciences, Kite pharma, Celgene, Karyopharm, MEI Pharma, Verastem, Incyte, Beigene, Johnson and Johnson, Dava Oncology, BMS, Merck, Cardinal Health, ADCT therapeutics, Epizyme, Caribou Biosciences, Cellecter Bisosciences Research funding: Pharmacyclics P. Ramakrishnan Geethakumari Consultant or advisory role: Kite Pharma, Bristol Myers Squibb, Rafael Pharma, Pharmacyclics LLC, ADC Therapeutics and Cellectar Biosciences

Insurance Trends in Patients Diagnosed with Melanoma Before and After the Affordable Care Act: A National Database Study

Background: The Affordable Care Act (ACA) was intended, in part, to reduce the uninsured population. It underwent full implementation in 2014 with optional state Medicaid expansion and health insurance marketplaces. Prior to the ACA, studies show that insurance status affects cancer care, including prevention, diagnosis, stage at diagnosis, and management. ACA impact on malignant melanoma is unknown. In this study, the primary objective is to examine the impact of the ACA on insurance rates among patients diagnosed with malignant melanoma. Survival by insurance type was also assessed. Methods: A retrospective analysis of the Surveillance, Epidemiology and End Results (SEER) cancer registry was performed for malignant melanoma between 2007 (first year of insurance da-ta in SEER) and 2015. Standardized mean differences were used for 2007-2013 and 2014-2015 (after full ACA implementation) for the primary objective. Sub-analysis was performed for Med-icaid expansion and non-expansion states. The impact of insurance type (uninsured, Medicaid, non-Medicaid) on all-cause and cause-specific mortality was assessed via adjusted cox regression models. Results: Nationally, the ACA decreased percentage of uninsured patients (-1.12% to -2.26%, P&lt;0.05) and increased percentage of Medicaid enrollees (+1.53% to +4.02%, P&lt;.005) diagnosed with malignant melanoma. Expansion states showed decreased percentage of uninsured patients (-1.43% to -2.24%, P&lt;0.05) and increased percentage of Medicaid enrollees (+1.66% to +4.84%, P&lt;0.05). Non-expansion states showed no change in percentages of uninsured patients and Medicaid enrollees. All-cause and cause-specific mortality were decreased in uninsured and Medicaid patients diagnosed with malignant melanoma compared to non-Medicaid insured patients (reference group). Discussion: The ACA decreased the rate of patients diagnosed with malignant melanoma with uninsured status, but this was only significant in Medicaid expansion states. Although diagnosis of melanoma is associated with High Socioeconomic Status (SES), Medicaid expansion seems to have increased access to dermatologic care. Increasing the number of states expanding Medicaid may be beneficial. However, Medicaid patient have worse all-cause and cause-specific mortality compared to non-Medicaid insured patients. Addressing these disparities through policy is important to ensure insurance coverage translates to better outcomes.

Improved 3 Year Heart Transplant Survival in Black recipients Following the Affordable Care Act.

To improve healthcare access, the US government implemented the Affordable Care Act (ACA) in 2014. Previous studies investigating its impact on healthcare inequities showed significant improvement in Black transplant recipient outcomes. Our objective is to determine the ACA's impact on Black heart transplant (HTx) recipients. Using the United Network for Organ Sharing database, we analyzed 3,462 Black HTx recipients pre- and post-ACA (January 2009 to December 2012, and January 2014 to December 2017). Black recipient numbers and rates of overall HTx, insurance effects on survival, geographic changes in HTx, and post-HTx survival were compared pre- and post-ACA. Black recipients increased from 1,046 (15.3%) to 2,056 (22.2%) post-ACA (p < 0.001). Three year survival increased among Black recipients (85.8-91.9%, p = 0.01; 79.4-87.7%, p < 0.01; 78.3-84.6%, p < 0.01). Affordable Care Act implementation was protective for survival (hazard ratio [HR] = 0.64 [95% confidence interval [CI], 0.51-0.81], p < 0.01). Publicly insured patient survival increased post-ACA to match that of privately insured (87.3-91.8%, p = 0.001). United Network for Organ Sharing (UNOS) Regions 2, 8, and 11 experienced improved survival post-ACA (p = 0.047, p = 0.02, and p < 0.01, respectively). The post-ACA era showed improved HTx access and survival in Black recipients, indicating that national medical policy may play a strong role in eliminating racial disparities. Further attention is required to improve inequities in medical care.

The Affordable Care Act and its Effects on Trauma Care Access, Short- and Long-term Outcomes and Financial Impact: A Review Article.

The purpose of this study is to evaluate the current evidence regarding the impact of the ACA on trauma outcomes and the financial impact on trauma patients and trauma systems. Traumatic injuries are the leading cause of death and disability between the ages of 1 to 47 years. Uninsured status has been associated with worse outcomes and higher financial strain. The Affordable Care Act (ACA) was signed into law with the aim of increasing health insurance coverage. Despite improvements in insured status, it is unclear how the ACA has affected trauma. We conducted a literature search using PubMed and Google Scholar for peer-reviewed studies investigating the impact of the ACA on trauma published between January 2017 and April 2021. Our search identified 20 studies that evaluated the impact of ACA implementation on trauma. The evidence suggests ACA implementation has been associated with increased postacute care access but not significant changes in trauma mortality. ACA implementation has been associated with a decreased likelihood of catastrophic health expenditures for trauma patients. ACA was also associated with an increase in overall reimbursement and amount billed for trauma visits, but a decrease in Medicaid reimbursement. Some improvements on the financial impact of ACA implementation on trauma patients and trauma systems have been shown, but studies are limited by methods of calculating costs and by inconsistent pre-/post-ACA timeframes. Further studies on cost-effectiveness and cost-benefit analysis will need to be conducted to definitively determine the impact of ACA on trauma.

Physician Reimbursement for Vascular Surgery Procedures and Vascular Laboratory Studies Before and After the Affordable Care Act

The Patient Protection and Affordable Care Act (ACA), fully implemented by 2015, has significantly increased the number of Americans with health insurance. However, its impact on physician reimbursement (PR) is not well studied. Our objective was to determine the ACA's impact on the professional component of PR for selected vascular surgery (VS) procedures and vascular laboratory (VL) studies at our institution. PR for the following 5 VS procedures and 4 VL studies were obtained from our billing department: CPT 34803 (Endovascular aortic repair, EVAR), 35301 (carotid endarterectomy, CEA), 35656 (lower extremity bypass, LEB), 36010 (introduction of catheter into vena cava, ICVC), 36200 first, 93922 (ankle brachial index, ABI), 93925 (lower extremity arterial duplex, LEA duplex), 93970 (lower extremity venous duplex, LEV Duplex), and 93990 (hemodialysis duplex). The data was organized by payer: Medicare, Medicaid, Commercial Insurers (CI), and Other. PR was studied pre-ACA (January 2008 through December 2009) and post-ACA (January 2015 through December 2016). The post-ACA PR and inflation adjusted reimbursement (IAR) in 2016 dollars using the consumer price index (CPI) were calculated and compared using one-sample t-test. The percent difference between the post-ACA PR and IAR was also compared. PR for 1,637 VS procedures and 16,333 VL studies was analyzed. The post-ACA PR was significantly lower than the IAR for most Medicare and Medicaid procedures. For EVAR, post-ACA reimbursement was overall on par with the IAR but significantly lower for Medicare. For CEA, post-ACA reimbursement was overall lower than IAR. For LEB, overall average PR was lower than IAR, with statistically significant lower Medicare and Medicaid (P < 0.001) payments. For ICAo, overall PR was significantly lower than the IAR and this was true across all insurance types. In contrast, for ICV, the post-ACA reimbursement was higher than IAR for all payers but did not reach statistical significance (P=0.25). The post-ACA PR was significantly higher than the IAR for most VL studies, except for Medicare PR. The percent change for VS procedures were mostly negative for the Medicaid and Medicare groups. This results in potential annual shortcomings of $2, 862 and $20,923 respectively. When comparing reimbursement before and after ACA implementation, Medicare and Medicaid PR for most VS procedures has not kept up with inflation. However, for most VL procedures, PR has exceeded inflation. Further efforts are needed to support Vascular Surgery reimbursement including higher valuation of the Medicare Conversion factor.

Influence of social determinants of health on timeliness to treatment for metastatic HCC and the impact of affordable care act

Influence of social determinants of health on timeliness to treatment for metastatic HCC and the impact of affordable care act

Exploring the Impact of ACA on Rural-Urban Disparity in Oral Health Services Among US Noninstitutionalized Adults.

To explore the effect of the Affordable Care Act (ACA) on rural disparities in oral health services utilization based on disability status. Comparing the 2011-2013 with the 2014-2016 Medical Expenditure Panel Survey, the study estimated the impacts of ACA on the likelihood of having preventive checkup and utilization of dental treatments in adults older than 18. The sample consists of 216,184 noninstitutionalized adults with 14.5% living in rural areas. There was a slight improvement in the receipt of oral health services after ACA, but the improvement was not statistically significant. Disability remains a barrier to receiving preventive oral health checkups, and living in rural areas is a barrier for both utilization of preventive checkups and dental treatments. Unmet needs for preventive checkups may result in unnecessary, costly dental treatments. More strategies are needed to reduce the disparities in oral health services.

Did the Affordable Care Act Reach Penetrating Trauma Patients?

BackgroundThe benefits of the Affordable Care Act (ACA) for trauma patients have been well established. However, the ACA's impact on penetrating trauma patients (PTPs), a population that is historically young and uninsured, has not been defined. We hypothesized that PTPs in the post-ACA era would have better outcomes. Material and methodsThe National Trauma Data Bank (NTDB) was queried for all PTPs from 2009 (pre-ACA) and 2011-2014 (post-ACA). Subset analysis was performed in patients aged 19-25 y, as this group was eligible for the ACA's dependent care provision (DCP). ResultsThere were 9,714,471 patients in the study, with 2,053,501 (21.1%) pre-ACA and 7,660,970 (78.9%) post-ACA. When compared to pre-ACA, patients in the post-ACA cohort were more likely to have commercial/private insurance, less likely to have Medicaid, and more likely to be uninsured. On logistic regression, the pre-ACA era was associated with mortality (HR: 1.02, 95% CI: 1.01-1.04, P = 0.004). Being uninsured was associated with mortality (HR: 1.89, 95% CI: 1.87-1.92, P < 0.001). On subset analysis of the DCP age group, post-ACA patients were more likely to be uninsured (24.1% versus 17.6%; P < 0.001). In addition, for the DCP age group, pre-ACA era was not associated with mortality (HR: 1.03, 95% CI: 0.99-1.06, P = 0.20). ConclusionsAlthough the ACA provided a survival benefit to PTPs overall, it did not increase insurance coverage for this population. In addition, the DCP of the ACA did not improve insurance access for PTP in the eligible age group. Further efforts are needed to extend insurance access to this population.

“It’s a Trade off:” Perspectives of Ryan White Social Service Providers on the Implementation of the Affordable Care Act

The Patient Protection and Affordable Care Act (ACA) was expected to reduce health disparities, including among people living with HIV. The aim of this study was to explore experiences of Ryan White HIV/AIDS Program social service providers in a Medicaid-expansion southwestern state. Thematic analysis of semi-structured focus groups revealed that participants view the ACA implementation as posing impossible bureaucratic demands and increasing role conflict. Participants described the ACA impact on clients as “a trade off,” with greater medical coverage for some clients, along with increased red tape and challenges for at-risk groups and for their therapeutic alliance with clients. These findings highlight the importance of incorporating the perspectives of providers in planning and implementing policy changes and in measuring the quality of HIV services.

Did the Affordable Care Act Reach Penetrating Trauma Patients?

Abstract Background The benefits of the Affordable Care Act (ACA) for trauma patients have been well established. However, the ACA's impact on penetrating trauma patients (PTPs), a population that is historically young and uninsured, has not been defined. We hypothesized that PTPs in the post-ACA era would have better outcomes. Material and methods The National Trauma Data Bank (NTDB) was queried for all PTPs from 2009 (pre-ACA) and 2011-2014 (post-ACA). Subset analysis was performed in patients aged 19-25 y, as this group was eligible for the ACA's dependent care provision (DCP). Results There were 9,714,471 patients in the study, with 2,053,501 (21.1%) pre-ACA and 7,660,970 (78.9%) post-ACA. When compared to pre-ACA, patients in the post-ACA cohort were more likely to have commercial/private insurance, less likely to have Medicaid, and more likely to be uninsured. On logistic regression, the pre-ACA era was associated with mortality (HR: 1.02, 95% CI: 1.01-1.04, P = 0.004). Being uninsured was associated with mortality (HR: 1.89, 95% CI: 1.87-1.92, P Conclusions Although the ACA provided a survival benefit to PTPs overall, it did not increase insurance coverage for this population. In addition, the DCP of the ACA did not improve insurance access for PTP in the eligible age group. Further efforts are needed to extend insurance access to this population.

2844 Does Access Matter? A Retrospective Analysis of Patients Undergoing Colonoscopy for Colorectal Cancer Screening Based on Health Insurance

INTRODUCTION: Implementation of the Affordable Care Act (ACA) in 2010 has expanded access to health care for millions of Americans. Although there were few large registry based studies that showed a positive impact of ACA on colorectal cancer screening and early cancer detection there are no published studies from community practice setting. The aim of this retrospective study in a single provider gastroenterology community practice is to study the ultilization of colonoscopy for colorectal cancer screening among patients with health exchange plans. METHODS: This is a retrospective study from a single provider gastroenterology community practice. All the patients who had colonoscopy for colon cancer screening between January 1st 2018 and December 31, 2018 were extracted from the database. Colorectal polyp rates based on health insurance plan (health exchange AC insurance/commercial insurance/Medicare and Tricare) were studied. RESULTS: A total of 746 (Male 310, Female 436) patient records who had a colonoscopy for screening were reviewed. Median age was 59 years. 54% (400/746) of them had Affordable Care Insurance. 59% (437/746) were found to have polyps. Among those with colon polyps 49% (214/437) had Affordable Care Insurance, 28% had commercial insurance and 22% had Medicare and Tricare. 54% (214/400; median age 59) of patients with health exchange plans, 73% (98/135; median age 69) of patients with medicare/tricare, 59% (120/202; median age 57) of patients with commercial insurance plans had colon polyps. CONCLUSION: About half of the patient cohort with colorectal polyps relied on Affordable Care Insurance to receive colorectal cancer screening. About 74% of patients with colorectal polyps were under the age of 65. As expected patients with medicare plan had high rates of colorectal polyps (73%) compared to commercial and health exchange insurance plans. If access to preventive care via ACA is not available a significant proportion of patients with colorectal polyps would have not had their screening. If they were to wait untill they are eligible for medicare to get their colonoscopy for screening a significant proportion of these patients would develop advanced adenomas or cancer. So it is important to have access to preventive health via ACA. This issue is particularly more important now with attention being brought to the ACA and the possibility of it being repealed.

Physician Reimbursement for Vascular Surgery Procedures and Vascular Laboratory Studies Before and After the Affordable Care Act

The Patient Protection and Affordable Care Act (ACA), fully implemented by 2015, has significantly increased the number of Americans with health insurance. However, its impact on physician reimbursement (PR) is not well studied. Our objective was to determine the ACA's impact on the professional component of PR for selected vascular surgery (VS) procedures and vascular laboratory (VL) studies at our institution. PR for the following five VS procedures and three VL studies were obtained from our billing department: CPT 34803 (endovascular aneurysm repair), 35301 (carotid endarterectomy [CEA]), 35656 (lower extremity bypass [LEB]), 36010 (introduction of catheter into vena cava), 35200 (introduction of catheter into aorta [ICAo]), 93922 (ankle-brachial index), 93925 (lower extremity arterial duplex ultrasound), and 93970 (lower extremity venous [LEV] duplex ultrasound). The data were organized by payer: Medicare, Medicaid, commercial insurers (CIs), and other. PR was studied before the ACA (January 2008-December 2009) and after the ACA (January 2015-December 2016). The post-ACA PR and insurance-adjusted reimbursement (IAR) in 2016 dollars using the Consumer Price Index were calculated and compared using one-sample t-test. The percentage difference between the post-ACA PR and IAR was also compared. PR for 1704 VS procedures and 18,904 VL studies was analyzed. The post-ACA PR was significantly lower than the IAR for most Medicare procedures (CEA, LEB, and ICAo) and Medicaid procedures (CEA, LEB, introduction of catheter into vena cava) and for ICAo for all payers. The post-ACA PR was significantly higher than the IAR for ankle-brachial index for all payers; lower extremity arterial duplex ultrasound for Medicare, other, and CIs; and LEV duplex ultrasound for Medicaid and CIs. Only Medicare LEV duplex ultrasound had post-ACA PR that was significantly lower than IAR (Table). The percentage differences for VS procedures were mostly negative for the Medicaid and Medicare groups but were more varied in the CIs and other payer groups (Fig). In comparing reimbursement before and after ACA implementation, PR for most VS procedures has not kept up with inflation. However, for most VL procedures, PR has exceeded inflation. Further efforts are needed to support VS reimbursement, including higher valuation of the Medicare conversion factor.TableComparison of post-Affordable Care Act (ACA) reimbursement and insurance adjusted reimbursement (IAR)InsurancePost-ACA reimbursement, $IAR, $P valueCPT 34803, EVARMedicare1283.511174.92<.001Medicaid1141.831108.47N/AaOther1687.691126.51.659Private1720.491643.54.927CPT 35301, CEAMedicare1119.721300.93<.001Medicaid1033.181342.13.007Other1337.141315.60.912Private1817.951753.01.423CPT 35656, LEBMedicare947.811257.25<.001Medicaid963.371363.13<.001Other693.361258.27.248Private1713.051792.02.732CPT 36010, ICVCMedicare71.1280.22.444Medicaid67.3193.76.045Other457.03152.81.424Private146.99148.32.945CPT 36200, ICAoMedicare112.01185.09<.001Medicaid84.98172.73<.001Other255.14155.00.022Private208.36268.73<.001CPT 93922, ABIMedicare24.6011.74<.001Medicaid25.0711.10<.001Other31.0416.90<.001Private53.1122.47<.001CPT 93925, LEA duplex ultrasoundMedicare79.1940.43<.001Medicaid54.2336.18.298Other141.9234.24.014Private138.0454.94<.001CPT 93970, LEV duplex ultrasoundMedicare35.8246.41<.001Medicaid47.2830.17<.001Other43.9346.08.386Private93.3466.04<.001ABI, Ankle-brachial index; CEA, carotid endarterectomy; EVAR, endovascular aneurysm repair; ICAo, introduction of catheter into aorta; ICVC, introduction of catheter into vena cava; LEA, lower extremity arterial; LEB, lower extremity bypass; LEV, lower extremity venous; N/A, not applicable.aNumber too low for statistical calculation. Open table in a new tab

Effect of Affordable Care Act Medicaid Expansion on Emergency Department Visits by Uninsured Patients in Illinois 2009-2015

Introduction: Medicaid expansion was one of the key provisions of the Affordable Care Act (ACA) designed to reduce the number of people without health insurance. The ACA extended Medicaid coverage to all adult citizens with annual incomes up to 133% of the federal poverty level. Purpose: Our study objective was to study the impact of ACA on Uninsured Emergency Department Visits (UiEDV). Methods: We downloaded aggregated EDV …

Costs and Trends of Emergency Department Utilization Pre-ACA and Post-ACA: Evidence From a Rural Georgia Hospital.

A high volume of emergency department (ED) visits in the rural United States may be the result of barriers to accessing primary care. The Affordable Care Act (ACA) increased the number of insured, which may improve patient access to primary care and therefore reduce ED utilization. The objective of this study is to estimate the trends and cost of ED utilization pre-ACA and post-ACA implementation in a rural United States. We use 2009-2013 ED utilization data from a rural Georgia hospital to estimate trends and costs by demographic characteristics, referring source, and payor information. T tests and log-linear regression models are used to assess the sociodemographic factors impacting ED inflation-adjusted costs before (2009-2010) and after ACA (2011-2013) implementation. During 2009-2013, 39,970 ED encounters were recorded with an average cost (AC) of $2002 per visit. Results indicate that during pre-ACA, on average, 8702 encounters were recorded per year with an AC of $1759. During post-ACA, there were 7521 annual visits, with an annual AC of $2241. Regression model results indicate that AC were significantly higher for men, older adults, nonblack patients, those with private insurance, and during the post-ACA period. Results suggest that post-ACA, declining ED visits may be due to more patients with insurance accessing primary care instead of ED. We further hypothesize that increased AC during this period may be due to ED visits being of an emergent nature, which require more resources to treat. Further comprehensive investigation is warranted to study the impact of ACA on ED utilization for nonemergency purposes among rural and nonrural hospitals.

THE EFFECTS OF THE AFFORDABLE CARE ACT ON HEALTH INSURANCE COVERAGE AND LABOR MARKET OUTCOMES

The Affordable Care Act (ACA) includes several provisions designed to expand insurance coverage that also alter the tie between employment and health insurance. In this paper, we exploit variation across geographic areas in the potential impact of the ACA to estimate its effect on health insurance coverage and labor market outcomes in the first two years after the implementation of its main features. Our measures of potential ACA impact come from pre-existing population shares of uninsured individuals within income groups that were targeted by Medicaid expansions and federal subsidies for private health insurance, interacted with each state’s Medicaid expansion status. Our findings indicate that the majority of the increase in health insurance coverage since 2013 is due to the ACA and that areas in which the potential Medicaid and exchange enrollments were higher saw substantially larger increases in coverage. While labor market outcomes in the aggregate were not significantly affected, our results indicate that labor force participation reductions in areas with higher potential exchange enrollment were offset by increases in labor force participation in areas with higher potential Medicaid enrollment

The impact of ACA on medical financial hardship among cancer survivors.

e18160 Background: Prior research has documented that privately insured cancer patients are exposed to significant financial burdens which can result in bankruptcy. A key provision of the Affordable Care Act (ACA) was to set limits on patients out-of-pocket (OOP) spending, which was implemented in 2014. This study aims to assess if OOP limits reduces financial hardship. Methods: Using the 2000-2017 National Health Interview Survey we identified cancer survivors under age 65. We performed a difference in difference analysis which compared financial hardship for low- or moderate-income individuals (LMII), family income under $50,000, to those with higher incomes before and after OOP limits were implemented for privately insured patients. Financial hardship was measured in the following ways: delayed medical care due to cost and the number of family members delayed medical care due to costs, could not afford a prescription, medical care or seeing a specialist, and problems paying medical bills. We used multivariate regression models adjusting for age, race, marital status, gender and size of family. All analyses accounted for the complex survey design and weights. Results: We identified 20,879 privately insured, cancer survivors age 65 or younger. The impact of the ACA resulted in lower financial hardships for LMII compared to higher income persons for most outcomes. The impact of the OOP limits on financial hardship for LMII was seen in any family member delaying care due to costs (difference-in-difference (DiD) = -3.6%; 95% CI = -5.9%, -1.5%; p-value = 0.002), number of family members delaying care due to costs (DiD = -0.048; 95% CI = -0.082, -0.135; p-value = 0.002), had problems paying medical bills (DiD = -3.3%; 95% CI = -6.3%, -0.4%; p-value = 0.028), could not afford prescription medication (DiD = -2.3%; 95% CI = -4.2%, -0.3%; p-value = 0.023), could not afford medical care (DiD = -1.9%; 95% CI = -3.5%, -0.3%; p-value = 0.021), but there was no statistically significant difference in the ability to afford seeing a specialist (DiD = -1.1%; 95% CI = -2.6%, -0.5%; p-value = 0.002). Conclusions: Little research has examined the impact of the ACA’s OOP spending limits. In this study we find that after the introduction of OOP spending limits, financial hardship measured in a variety of ways significantly decreased for LMII.

Early Impact of the Patient Protection and Affordable Care Act on People Living With HIV: A Systematic Review.

The US Patient Protection and Affordable Care Act (ACA) was the most influential policy-related change to the care of people living with HIV in decades. We systematically searched and analyzed peer-reviewed, empirical research reporting on ACA-related aspects of HIV care post-ACA full implementation, finding 12 articles that met search criteria. The results revealed largely positive evidence regarding the ACA impact on people living with HIV, particularly on their health care coverage in Medicaid expansion states. More recent reporting included improvement in virologic suppression. However, early evidence has been somewhat fragmented, and important questions concerning the impact of the ACA on HIV care quality, patients, and providers remain unanswered. As the political struggle over the ACA continues, future analyses should use national- and state-level data to examine ACA impact on HIV care quality and patient-centered health outcomes to provide in-depth, holistic understanding of HIV care in the wake of this policy change.

Perceptions of the affordable care act by Physician Assistants

Objective: Implementation of the affordable care act (ACA) resulted in an increased number of insured individuals and a shortage of primary care physicians. Physician Assistants (PAs) are poised to address this shortage since the PA profession is grounded in teamwork exemplified by the Accountable Care Organizations supported by the ACA. This study assesses the perception of the ACA by PAs providing healthcare services during implementation of the ACA.Methods: In this repeated cross-sectional study, alumni from a Midwest PA program were surveyed in 2014, 2016 and 2018 on knowledge and perception of the ACA. Questions addressed the ACA impact on the PA profession and on patients’ access to healthcare.Results: During the initial four years of ACA implementation, the following increases in perception were seen: 1) 32% increase in positive outlook of healthcare; 2) 37% increase in positive influence on PA practice; 3) 30% increase in positive impact of practice autonomy; 4) 64% increase in positive impact for patients; and 5) 33% increase in patient access to care. Additionally, the inability to choose a provider increased by 18%.Conclusions: Over the last four years PAs have perceived positive effects pertaining to their practice and regarding the impact on their patients despite an increase in the inability to choose a provider. Inability to choose a provider may in part be due to the rising number of narrow-network plans. The findings of greater autonomy and increased compensation for PAs are contrary to physicians who perceive the ACA to decrease their autonomy and their compensation.