Impact Of Medicaid Expansion Research Articles

The impact of Medicaid expansion on cervical cancer outcomes

The impact of Medicaid expansion on cervical cancer outcomes

Impact of Medicaid expansion on cervical cancer screening rates: A state-specific difference in difference analysis

Impact of Medicaid expansion on cervical cancer screening rates: A state-specific difference in difference analysis

The impact of Medicaid expansion under the Affordable Care Act on HIV care continuum outcomes across the United States.

HIV care continuum outcome disparities by health insurance status have been noted among people with HIV (PWH). We therefore examined associations between state Medicaid expansion and HIV outcomes in the United States. Adults (≥18 years) with ≥1 visit in NA-ACCORD clinical cohorts from 2012-2017 contributed person-time annually between first and final visit or death; in each calendar year, clinical retention was ≥2 completed visits > 90 days apart, antiretroviral therapy (ART) receipt was receipt of ≥3 antiretroviral agents, and viral suppression was last measured HIV-1 RNA < 200 copies/mL. CD4 at enrollment was obtained within 6 months of enrollment in cohort. Difference-in-difference (DID) models quantified associations between Medicaid expansion changes (by state of residence) and HIV outcomes. Across 50 states, 87 290 PWH contributed 325 113 person-years of follow-up. Medicaid expansion had a substantial positive effect on CD4 at enrollment (DID = 93.5, 95% CI: 52.9, 134 cells/mm3), a small negative effect on proportions clinically retained (DID = -0.19, 95% CI: -0.037, -0.01), and no effects on ART receipt (DID = 0.001, 95% CI: -0.003, 0.005) or viral suppression (DID = -0.14, 95% CI: -0.34, 0.07). Medicaid expansion had a positive effect on CD4 at entry, suggesting more timely HIV testing and care linkage, but generally null effects on downstream HIV care continuum measures.

Impact of Medicaid expansion on receipt of pancreatectomy in early-stage pancreatic cancer.

106 Background: Pancreatic cancer is estimated to rank third in cancer-related mortality in 2024 by the American Cancer Society. Despite the proven increase in 5-year survival with pancreatectomy in Early Pancreatic Cancer (EPC), it is nationally underutilized. Medicaid expansion (ME) under the Affordable Care Act is associated with gains in insurance coverage and early cancer diagnosis in patients with pancreatic cancer. However, its impact on the receipt of pancreatectomy in EPC remains unclear. In this study, we looked at the impact of ME on the uptake of pancreatectomy in EPC. Methods: We performed a retrospective observational study using the Surveillance, Epidemiology, and End Results (SEER) database, which included patients diagnosed with EPC (Stage 1 and Stage 2) between 2006 and 2021. Multivariate logistic regression was performed to ascertain the effects of ME on the uptake of pancreatectomy in patients with EPC in states that expanded vs. states that did not, with 2014 as an inflection point for policy implementation. Results: During this study period, 29,384 were diagnosed with EPC, 10,777 patients were diagnosed pre-ME and 18,607 post-ME. The odds of receipt of pancreatectomy for EPC in non-expansion states after 2014 was 20% higher than before 2014. However, this was not statistically significant [AOR – 1.20 (0.98-1.48)]. There was also no significant difference between the odds of receipt of treatment for EPC for ME states before [AOR- 1.27 (1.06-1.51)] and after [AOR-1.21 (1.01-1.44)] 2014. Increasing age, male sex, Black and Hispanic race, having an income lower than $65,000, and living in less populated areas were all associated with lower odds of receipt of pancreatectomy in EPC. Conclusions: ME was not associated with increased uptake of pancreatectomy in EPC. However, prior studies have shown that ME is linked to an earlier stage at pancreatic cancer diagnosis. This suggests that despite earlier diagnosis, other barriers to receiving treatment exist. Future studies are warranted to identify the limitations of policy change to improve outcomes of such aggressive cancer. Logistic regression for receipt of pancreatectomy in early-stage pancreatic cancer. Receipt of Surgical Treatment for Early Pancreatic cancer Adjusted Odds Ratio (95% Confidence Interval) Non- ME States (Pre-Expansion) 1.00 (Reference) Non- ME States (Post -Expansion) 1.20 (0.98-1.48) ME States (Pre-Expansion) 1.27 (1.06-1.51) ME States (Post-Expansion) 1.21 (1.01-1.44) ME- Medicaid expansion.

The impact of the Affordable Care Act Medicaid Expansion in Medicare beneficiaries with peripheral artery disease.

Background: In 2014, the Affordable Care Act Medicaid Expansion (ME) increased Medicaid eligibility for adults with an income level up to 138% of the federal poverty level. In this study, we examined the impact of ME on mortality and amputation in patients with peripheral artery disease (PAD). Methods: The 100% MedPAR and Part-B Carrier files from 2011 to 2018 were queried to identify all fee-for-service Medicare beneficiaries with PAD using International Classification of Diseases codes. Our primary exposure was whether a state had adopted the ME on January 1, 2014. Our primary outcomes were the change in all-cause 1-year mortality and leg amputation. We used a state-level difference-in-differences (DID) analysis to compare the rates of the primary outcomes among patients who were in states (including the District of Columbia) who adopted ME (n = 25) versus those who were in states that did not (n = 26). We performed a subanalysis stratifying by sex, race, region, and dual-eligibility status. Results: Over the 8-year period, we studied 37,743,929 patients. The average unadjusted 1-year mortality decreased from 2011 to 2018 in both non-ME (9.5% to 8.7%, p < 0.001) and ME (9.1% to 8.3%, p < 0.001) states. The average unadjusted 1-year amputation rate did not improve in either the non-ME (0.86% to 0.87%, p = 0.17) or ME (0.69% to 0.69%, p = 0.65) states. Across the entire cohort, the DID model revealed that ME did not lead to a significant change in mortality (p = 0.15) or amputation (p = 0.34). Conclusion: Medicaid Expansion was not associated with reduced mortality or leg amputation in Medicare beneficiaries with PAD.

The impact of the affordable care act and Medicaid expansion on colorectal cancer screening: Evidence from the 5th year of Medicaid expansion.

Colorectal cancer screening rates remain suboptimal, particularly among low-income populations. Our objective was to evaluate the long-term effects of Medicaid expansion on colorectal cancer screening. This cross-sectional study analyzed data from 354,384 individuals aged 50-64 with an income below 400% of the federal poverty level (FPL), who participated in the Behavioral Risk Factors Surveillance System from 2010 to 2018. A difference-in-difference analysis was employed to estimate the effect of Medicaid expansion on colorectal cancer screening. Subgroup analyses were conducted for individuals with income up to 138% of the FPL and those with income between 139% and 400% of the FPL. The effect of Medicaid expansion on colorectal cancer screening was examined during the early, mid, and late expansion periods. The primary outcome was the likelihood of receiving colorectal cancer screening for low-income adults aged 50-64. Medicaid expansion was associated with a significant 1.7 percentage point increase in colorectal cancer screening rates among adults aged 50-64 with income below 400% of the FPL (p < 0.05). A significant 2.9 percentage point increase in colorectal cancer screening was observed for those with income up to 138% the FPL (p < 0.05), while a 1.5 percentage point increase occurred for individuals with income between 139% and 400% of the FPL. The impact of Medicaid expansion on colorectal cancer screening varied based on income levels and displayed a time lag for newly eligible beneficiaries. Medicaid expansion was found to be associated with increased colorectal cancer screening rates among low-income individuals aged 50-64. The observed variations in impact based on income levels and the time lag for newly eligible beneficiaries receiving colorectal cancer screening highlight the need for further research and precision public health strategies to maximize the benefits of Medicaid expansion on colorectal cancer screening rates.

Abstract 4791: Characterizing interventions to reduce disparities in lung-cancer screening uptake by state Medicaid expansion status: A scoping review

Abstract Background: Lung cancer is the leading cause of cancer-related deaths in the United States, and yet, lung cancer screening rates remain persistently low. Many interventions are being developed to address the low rates of lung cancer screening (LCS), including interventions that address the additional barriers faced by historically marginalized racial and ethnic populations as well as low-income and rural populations. However, the impact of Medicaid expansion on the types of interventions developed in non-expansion states and the efficacy of those interventions is not well understood. Methods: A research librarian conducted searches in MEDLINE via PubMed, Web of Science, and Embase. Results were screened and evaluated for eligibility by three reviewers in Covidence. Data was extracted from included studies after full-text review and analyzed using both a thematic analysis and a descriptive numerical summary of studies. The chosen framework was based on scoping review guidelines by Levac et al. and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Results: Of 4696 studies found through the initial search, 53 met inclusion criteria. This includes 34 studies in Medicaid expansion states (M) and 17 studies in non-Medicaid expansion states (NM). Two additional studies compared interventions implemented in a Medicaid expansion state to a similar intervention implemented in a non-expansion state. Studies in both groups were primarily focused on addressing disparities by race and ethnicity (M=74%; NM=65%), with fewer studies focusing on rurality (M=9%; NM=12%), income (M=9%; NM=0%), or multiple disparities (M=9%; NM=24%). In non-expansion states, the most common interventions were patient navigation (29%) and community outreach (24%). While in Medicaid expansion states, the most common interventions were EHR algorithms (24%) and decision aids (21%). The intervention setting for both Medicaid expansion and non-expansion states were most commonly in a hospital/health system (M=53%; NM=47%) or community setting (M=24%; NM=47%). Interventions in both groups typically showed some improvement in uptake of LCS, though the degree of impact was variable between studies. Conclusion: Due to continued barriers to access posed by inadequate insurance coverage, there is a critical need for interventions to reduce disparities in lung cancer mortality in states that have not expanded Medicaid. Interventions focused on patient navigation and community outreach have been effective in multiple settings in these states and could fill that gap. Citation Format: Miranda J. Reid, Caretia Washington, Meghann Wheeler, Lauren Adkins, Dejana Braithwaite, Ramzi Salloum. Characterizing interventions to reduce disparities in lung-cancer screening uptake by state Medicaid expansion status: A scoping review [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4791.

Impact of Medicaid Expansion on Trauma Patients at Extreme Risk of Mortality: A Time-Series Analysis.

The 2014 expansion of Medicaid under the Affordable Care Act (ACA) reshaped healthcare delivery in the United States. This study assessed how Medicaid expansion affected in-hospital mortality in patients with extreme risk of mortality (EROM) from traumatic injuries. Data from inpatients aged 18-64 years, registered in the National Inpatient Sample between 2007 and 2020, and identified with trauma-related All-Patient Refined Diagnosis Related Groups (APRDRG) codes, were analyzed. Within this group, a subset of patients was selected based on the APRDRG classification identifying them as at EROM for the principal unit of analysis. The cohort was divided into high-implementation (HIR) and low-implementation (LIR) regions based on Medicaid expansion coverage. In-hospital mortality was assessed using interrupted time-series analysis. Sensitivity analyses considered seasonality, autocorrelation, and exogenous events. Analysis encompassed 70381 trauma inpatient stays, corresponding to 346659 patients based on National Inpatient Sample weighting. There was a consistent monthly decline in in-hospital mortality of .08% (95% CI: -.103 to -.048; P < .001) prior to Medicaid expansion, a trend unaffected by expansion. This pattern persisted across both LIR and HIR Medicaid implementation regions. Although Medicaid enrollment increased in HIR, that in LIR remained unchanged. Over the study period, the in-hospital mortality among severely injured patients consistently decreased, and this trend was not influenced by Medicaid expansion. The statistical models and results from this study can offer valuable guidance to policymakers and healthcare leaders as they formulate more efficient and effective policies.

Lives Worth Saving: The Impact of Medicaid Expansion on Individuals in Recovery.

A quarter of a million North Carolinians admit to experienc-ing opioid use disorder; over 1,000 die each year. Only 1 in 5 receives effective, evidence-based treatment. Medicaid covers treatment and will increase access for members with opioid use disorder, who have been found to fare better than those with private insurance.

Impact of Medicaid expansion on pregnancy outcomes among women with gestational diabetes.

The Affordable Care Act (ACA) aims to broaden health care access and significantly impacts obstetric practices. Yet, its effect on maternal and neonatal outcomes among women with gestational diabetes across diverse demographics is underexplored. This study examines the impact of the implementation of the ACA on maternal and neonatal health in Maryland with ACA implementation and Georgia without ACA implementation. We used data from the Maryland State Inpatient Database and US Vital Statistics System to assess the ACA's influence on maternal and neonatal outcomes in Maryland, with Georgia serving as a nonexpansion control state. Outcomes compared include cesarean section (CS) rates, low Apgar scores, neonatal intensive care unit (NICU) admissions, and assisted ventilation 7 h postdelivery. We adjusted for factors including women's age, race, insurance type, preexisting conditions, prior CS, prepregnancy obesity, weight gain during pregnancy, birth weight, labor events, and antenatal practices. The study included 52 479 women: 55.8% from Georgia and 44.2% from Maryland. Post-ACA, CS rates were 45.1% in Maryland versus 48.2% in Georgia (P = 0.000). Maryland demonstrated better outcomes, including lower rates of low Agar scores (odds ratio [OR], 0.74 [95% confidence interval (CI), 0.63-0.86]), assisted ventilation (OR, 0.79 [95% CI, 0.71-0.82]), and NICU admissions (OR, 0.76 [95% CI, 0.71-0.82]), but no significant change in CS rates (OR, 0.96 [95% CI, 0.92-1.01]). After ACA implementation, Maryland showed improved maternal and neonatal outcomes compared with Georgia, a nonexpansion state.

Medicaid Expansion Increases Access for Rural and Impoverished Patients with Pancreatic Ductal Adenocarcinoma in Southern States.

Medicaid expansion (ME) impacted patients when assessed at a national level. However, of the 32 states in which Medicaid expansion occurred, only 3 were Southern states. Whether results apply to Southern states that share similar geopolitical perspectives remains elusive. We aimed to assess the impact of ME on pancreatic ductal adenocarcinoma (PDAC) treatment in eight Southern states in the USA. We identified uninsured or Medicaid patients (age 40-64 years) diagnosed with PDAC between 2011 and 2018 in Southern states from the North American Association of Central Cancer Registries-Cancer in North America (NAACCR-CiNA) research dataset. Medicaid-expanded states (MES; Louisiana, Kentucky, and Arkansas) were compared with non-MES (NMES; Tennessee, Alabama, Mississippi, Texas, and Oklahoma) using multivariate logistic regression. P < 0.05 was considered statistically significant. Among 3036 patients, MES significantly increased odds of Medicaid insurance by 36%, and increased proportions of insured Black patients by 3.7%, rural patients by 3.8%, and impoverished patients by 18.4%. After adjusting for age, race, rural-urban status, poverty status, and summary stage, the odds of receiving radiation therapy decreased by 26% for each year of expansion in expanded states (P = 0.01). Last, ME did not result in a significant difference between MES and NMES in diagnosing early stage disease (P = 0.98) nor in receipt of chemotherapy or surgery (P = 0.23 and P = 0.63, respectively). ME in Southern states increased insurance access to traditionally underserved groups. Interestingly, ME decreased the odds of receiving radiation therapy yearly and had no significant impact on receipt of chemotherapy or surgery.

The impact of Medicaid expansion and travel distance on access to transplantation

Most transplant centers require candidates be insured before they can join the waitlist for a deceased donor organ. After the Affordable Care Act, many uninsured Americans gained improved access to Medicaid. I examine the effect of this increase in access to insurance and find that Medicaid expansions significantly increase Medicaid-insured waitlist registrations by 39% and deceased donor transplants received by 44%, but the increase in registrations is larger for candidates who live closer to a transplant center. Additionally I show that most of these registrations would have been privately insured otherwise but provide suggestive evidence that this is better explained by improved access to subsidized private coverage due to other ACA reforms than from candidates with private coverage before the ACA switching to Medicaid coverage after expansion. This suggests that although the ACA improved access to the transplantation system, access is still limited for candidates who live far from centers.

1849. Impact of Medicaid Expansion on Human Immunodeficiency Virus Outcomes in Nebraska

Abstract Background Human immunodeficiency virus (HIV) viral suppression (VS) is a major predictor for improved clinical outcomes and decreased viral transmission in patients with HIV (PWH). There is evidence to suggest that enrollment in the Affordable Care Act (ACA) qualified health plan is associated with improved VS, however there is inconsistency in the literature on whether Medicaid enrollment can lead to similar outcomes. Previous research has shown that PWH living in Medicaid expansion states are more likely to be covered by Medicaid and less likely to be uninsured compared to those who live in non-expansion states. In 2014, the ACA Medicaid expansion went into effect and expanded Medicaid coverage to most adults with an income up to 138% of the Federal Poverty Level (PFL), which is $14,580 for an individual in 2023. Nebraska implemented the expansion October 2020. This provided an opportunity to further evaluate this gap in the literature using the data from the main provider of HIV care in Nebraska, the University of Nebraska Medical Center Specialty Care Center (UNMC SCC). Methods PWH were recruited from UNMC SCC for a retrospective observational study that included all patients 19 years of age or older that had at least one HIV provider clinic visit in the preceding 12 months before October 2020. If the patients had unknown income or were below 138% FPL and were not already enrolled in Medicare or out of state Medicaid, they were considered eligible for Medicaid expansion. PWH that were eligible and those that were not eligible for Medicaid expansion then had follow up viral loads compared to assess for VS. Results A diverse group of 1,069 patients were included in the study (Table 1). No statistically significant result was found between baseline VS, however those that were not eligible for Medicaid expansion showed a greater level of VS at follow up (Table 2), p=0.003. Conclusion This retrospective study found that approximately 1 year after Medicaid expansion in Nebraska, PWH that were not eligible for Medicaid expansion had better VS. This could be explained by a lack of those that were newly eligible for Medicaid being able to enroll among other reasons. This finding warrants further evaluation to assess for barriers to care, including but not limited to, Medicaid enrollment and its contribution to HIV VS. Disclosures All Authors: No reported disclosures

The Impact of Medicaid Expansion Under the Affordable Care Act on the Gap Between American Indians and Whites in Breast Cancer Management and Prognosis

BackgroundBreast cancer (BC) death rates in the USA have not significantly declined for American Indians (AIs) in comparison to Whites. Our objective was to determine whether Medicaid Expansion as part of the Affordable Care Act led to improved BC outcomes for AIs relative to Whites. Patients and MethodsUsing the National Cancer Database, we conducted a retrospective cohort study. Included were BC patients who were AI and White; 40 to 64 years of age; diagnosed in 2009 to 2016; lived in states that expanded Medicaid in January 2014, and states that did not expand Medicaid. Our outcomes were stage at diagnosis, insurance status, timely treatment, and 3-year mortality. ResultsThere were 359,484 newly diagnosed BC patients, 99.49% White, 0.51% AI. Uninsured rates declined more in the expansion states than in the nonexpansion states (OR = 0.44, 95% CI: 0.15-0.97, P < 0.001). Lower rates of Stage I BC diagnosis was found in AIs compared to Whites (46.58% vs. 55.33%, P < .001); these differential rates did not change after Medicaid expansion. Rates of definitive treatment initiation within 30 days of diagnosis declined after Medicaid expansion (P < .001); there was a smaller decline in the expansion states (OR 1.118, 95% CI: 1.09, 1.15, P < .001). Three year mortality was not different between expansion and nonexpansion states post Medicaid expansion. ConclusionsIn newly diagnosed BCs, uninsured rates declined more in the states that expanded Medicaid in January 2014. Timely treatment post Medicaid expansion declined less in states that expanded Medicaid. There was no differential benefit of Medicaid expansion in the 2 races.

Impact of Medicaid Expansion on Surgical Care and Outcomes for Hepatobiliary Malignancies.

As part of the Patient Protection and Affordable Care Act, some states expanded Medicaid eligibility to adults with incomes below 138% of the federal poverty line. While this resulted in an increased proportion of insured residents, its impact on the diagnosis and treatment of hepatopancreaticobiliary (HPB) cancers has not been studied. The National Cancer Database (NCDB) from 2010 to 2017 was used. Patients diagnosed with HPB malignancies in states which expanded in 2014 were compared to patients in non-expansion states. Subset analyses of patients who underwent surgery and those in high-risk socioeconomic groups were performed. Outcomes studied included initiation of treatment within 30days of diagnosis, stage at diagnosis, care at high volume or academic center, perioperative outcomes, and overall survival. Adjusted difference-in-differences analysis was performed. A total of 345,684 patients were included, of whom 55% resided in non-expansion states and 54% were diagnosed with pancreatic cancer. Overall survival was higher in states with Medicaid expansion (HR .90, 95% CI [.88-.92], P < .01). There were also better postoperative outcomes including 30-day mortality (.67 [.57-.80], P < .01) and 30-day readmissions (.87 [.78-.97], P = .02) as well as increased likelihood of having surgery in a high-volume center (1.42 [1.32-1.53], P < .01). However, there were lower odds of initiating care within 30days of diagnosis (.77 [.75-.80], P < .01) and higher likelihood of diagnosis with stage IV disease (1.09 [1.06-1.12], P < .01) in expansion states. While operative outcomes and overall survival from HPB cancers were better in states with Medicaid expansion, there was no improvement in timeliness of initiating care or stage at diagnosis.

Impact of Medicaid Expansion on Genital Gender-Affirming Surgery in New York State.

Impact of Medicaid Expansion on Genital Gender-Affirming Surgery in New York State.

Impact of Medicaid expansion on the multimodal treatment of biliary tract cancer.

The impact of Medicaid expansion (ME) on the treatment of patients with cancer remains controversial, especially individuals requiring complex multidisciplinary care. We sought to evaluate the impact of Medicaid expansion (ME) on receipt of multimodal care, including surgical resection, for Stage I-III biliary tract cancer (BTC). Patients diagnosed with BTC between 40 and 65 years of age were identified from the National Cancer Database and divided into pre- (2008-2012) and post- (2015-2018) ME cohorts. Difference-in-difference (DID) analysis was used to determine the impact of ME on the utilization of surgery and multimodal chemotherapy and/or radiotherapy treatment for BTC. Among 12,415 patients with BTC (extrahepatic, n = 5622, 45.3%; intrahepatic, n = 4352, 35.1%; gallbladder, n = 1944, 15.7%; overlapping, n = 497, 4.0%), 5835 (47.0%) and 6580 (53.0%) patients were diagnosed before versus after ME, respectively. Overall utilization of surgery (OR 1.13, 95% CI 1.02-1.26) and multimodality therapy (OR 1.13, 95% CI 1.01-1.27) increased in states that adopted ME. Utilization of surgery among uninsured/Medicaid patients in ME states increased relative to patients living in non-ME states (∆+10.1%, p = 0.01). Similarly, the use of multimodal treatment increased among uninsured/Medicaid patients living in ME versus non-ME states (∆+6.4%, p = 0.04); in contrast, there were no difference among patients with other insurance statuses (overall: ∆+1.5%, private: ∆-2.0%, other: ∆+3.9%, all p > 0.5). Uninsured/Medicaid patients with BTC who lived in a ME state had a lower risk of long-term death in the post-ME era (HR 0.81, 95% CI 0.67-0.98; p = 0.03). Implementation of ME positively impacted survival among patients who underwent surgical and multimodal treatment for Stage I-III BTC.

The Impact of Medicaid Expansion on Critical Access Hospitals: A Game-Changer for Healthcare Accessibility

Medicaid expansion has undeniably brought about a positive transformation in the landscape of healthcare accessibility, particularly for CAHs in states that have adopted this expansion. The increase in Medicaid funding resulting from higher, insured patient volumes has allowed CAHs to become more financially stable, invest in modern infrastructure and medical technology, and expand their scope of services. By continuing to expand Medicaid and invest in CAHs, the nation can ensure that healthcare remains accessible and affordable for all, particularly in underserved rural communities.

Impact of Medicaid Expansion and Firearm Legislation on Cost of Firearm Injuries

Firearm injury-related hospitalizations in the U.S. cost $900 million annually. Before the Affordable Care Act, government insurance programs covered 41% of the costs. This study describes the impact of Affordable Care Act Medicaid expansion and state-level firearm legislation on coverage and costs for firearm injuries. This cross-sectional study included 35,854,586 hospitalizations from 27 states in 2013 and 2016. Data analyses were performed in 2022. Firearm injuries were classified by mechanism: assault, unintentional, self-harm, or undetermined. The impact of the Affordable Care Act expansion was determined using difference-in-differences analysis. Differences in per capita costs between states with stronger and weak firearm legislation were compared using univariable and multivariable analyses. The authors identified 31,451 initial firearm injury-related hospitalizations. In states with weak firearm legislation, hospitalization costs per 100,000 residents were higher from unintentional ($25,834; p=0.04) and self-inflicted ($11,550; p=0.02) injuries; there were no state-level differences in assault or total per capita firearm-related hospitalization costs. Affordable Care Act expansion increased government coverage of costs by 15 percentage points (95% CI=3, 29) and decreased costs to uninsured/self-pay by 14 percentage points (95% CI=6, 21). In 2016, states with weak firearm legislation and no Affordable Care Act expansion had the highest proportion of hospitalization costs attributed to uninsured/self-pay patients (24%, 95% CI=15, 34). Affordable Care Act expansion increased government coverage of hospitalizations for firearm injuries. Unintentional and self-harm costs were significantly higher for states with weak firearm legislation. States with weak firearm legislation that did not expand Medicaid had the highest proportion of uninsured/self-pay patients.

Impact of Medicaid Expansion on Abdominal Surgery Morbidity, Mortality, and Hospital Readmission

IntroductionMedicaid expansion's (ME) impact on postoperative outcomes after abdominal surgery remains poorly defined. We aimed to evaluate ME's effect on surgical morbidity, mortality, and readmissions in a state that expanded Medicaid (Virginia) compared to a state that did not (Tennessee) over the same time period. MethodsVirginia Surgical Quality Collaborative (VSQC) American College of Surgeons National Surgical Quality Improvement Program data for Medicaid, uninsured, and private insurance patients undergoing abdominal procedures before Virginia's ME (3/22/18-12/31/18) were compared with post-ME (1/1/19-12/31/19), as were corresponding non-ME state Tennessee Surgical Quality Collaborative (TSQC) data for the same 2018 and 2019 time periods. Postexpansion odds ratios for 30-d morbidity, 30-d mortality, and 30-d unplanned readmission were estimated using propensity score-adjusted logistic regression models. ResultsIn Virginia, 4753 abdominal procedures, 2097 pre-ME were compared to 2656 post-ME. In Tennessee, 5956 procedures, 2484 in 2018 were compared to 3472 in 2019. VSQC's proportion of Medicaid population increased following ME (8.9% versus 18.8%, P < 0.001) while uninsured patients decreased (20.4% versus 6.4%, P < 0.001). Post-ME VSQC had fewer 30-d readmissions (12.2% versus 6.0%, P = 0.013). Post-ME VSQC Medicaid patients had significantly lower probability of morbidity (−8.18, 95% confidence interval: −15.52 ∼ −0.84, P = 0.029) and readmission (−6.92, 95% confidence interval: −12.56 ∼ −1.27, P = 0.016) compared to pre-ME. There were no differences in probability of morbidity or readmission in the TSQC Medicaid population between study periods (both P > 0.05); there were no differences in mortality between study periods in VSQC and TSQC patient populations (both P > 0.05). ConclusionsME was associated with decreased 30-d morbidity and unplanned readmissions in the VSQC. Data-driven policies accounting for ME benefits should be considered.