Association of Medicaid Expansion Under the Patient Protection and Affordable Care Act With Use of Long-term Care

Houtven, Courtney Harold Van; McGarry, Brian E.; Jutkowitz, Eric; Grabowski, David C.

doi:10.1001/jamanetworkopen.2020.18728

Cited by 16 publications

(16 citation statements)

References 24 publications

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“…This shift in cost from inpatient settings to outpatient settings would also be consistent with the hypothesis that Medicaid-eligible patients benefit from access to outpatient care, which may continue into their Medicare years and mitigate the risk and cost of hospitalizations for acute events. Interestingly, prior literature has suggested that Medicaid access is associated with an increase in utilization of long-term care, 34 including home health which is consistent with our findings, but also skilled nursing which was inconsistent with our findings. This could suggest that reduced Medicare spending on skilled nursing is merely an artifact of shifting the burden to Medicaid, which is an important source of skilled nursing reimbursement.…”

Section: Discussioncontrasting

confidence: 87%

A County-level Analysis of the Association Between Medicaid Expansion and Medicare Spending

El-Nahal

Eisenberg

2022

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Background: If access to Medicaid improves health outcomes, it may also result in lower long-term spending, however the association between Medicaid expansion and Medicare spending is unknown. In this analysis we sought to investigate the association between Medicaid expansion and per capita Medicare spending at the county level. Methods: This is an observational analysis of all U.S. counties in the ten years from 2010 to 2019. We used a difference-in-difference event study to investigate the difference in per capita Medicare spending between counties in states that expanded Medicaid and counties in states that did not expand Medicaid. The exposure was treatment year, which characterized whether a county was in an expansion state and when expansion occurred. In non-expansion counties, treatment year was assigned 0 for all observations. In expansion counties, treatment year ranged from -3 to +6, with treatment year 1 corresponding to the first full year of expansion. The primary outcome was fee-for-service Medicare spending per capita in each county. A secondary analysis investigated subcategories of per capita spending including inpatient, outpatient, skilled nursing care, inpatient rehabilitation, home health, and hospice care. Results: We analyzed 1,648 expansion and 1,494 non-expansion counties, with ten observations per county, one for each year between 2010 and 2019. In the adjusted event study analysis, the difference between expansion and non-expansion counties in expansion year 5 compared to pre-expansion was -200 [95% Confidence Interval (CI): -406, 6] dollars. In the subcategory analysis, the difference in inpatient care, skilled nursing care, outpatient care, and home health spending were -46 [95% CI: -103, 12], -92 [95% CI: -194, 11], 57 [95% CI: -67, 181], and 55 [95% CI: -17, 126] dollars per capita respectively. Conclusions: Medicaid expansion is not consistently significantly associated with lower Medicare spending compared to pre-expansion. However, observed trends towards lower spending and cost-shifting from inpatient to outpatient settings in expansion counties warrant additional investigation.

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Section: Discussioncontrasting

confidence: 87%

A County-level Analysis of the Association Between Medicaid Expansion and Medicare Spending

El-Nahal

Eisenberg

2022

Preprint

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“…Positive effects may result from several mechanisms such higher disposable income (e.g., by reducing out of pocket expenses), better access to health care (to address acute and chronic conditions that destabili e one s life in other domains such as work) and lower costs in the event of needing care (averting catastrophic costs). Similarly, Medicaid expansion improved the access to formal paid long-term care (Van Houtven et al, 2020). However, the effects of ACA-Medicaid expansion are specifically important among a population that otherwise has limited access to insurance because they perform caregiving duties low-income caregiving spouses.…”

Section: Medicaid Expansionmentioning

confidence: 99%

Medicaid Expansion and the Mental Health of Spousal Caregivers

2021

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Any opinions expressed in this paper are those of the author(s) and not those of IZA. Research published in this series may include views on policy, but IZA takes no institutional policy positions. The IZA research network is committed to the IZA Guiding Principles of Research Integrity. The IZA Institute of Labor Economics is an independent economic research institute that conducts research in labor economics and offers evidence-based policy advice on labor market issues. Supported by the Deutsche Post Foundation, IZA runs the world's largest network of economists, whose research aims to provide answers to the global labor market challenges of our time. Our key objective is to build bridges between academic research, policymakers and society. IZA Discussion Papers often represent preliminary work and are circulated to encourage discussion. Citation of such a paper should account for its provisional character. A revised version may be available directly from the author.

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“…9 In the few studies that have examined these trends beyond the first 2 years of coverage expansion, increases in coverage, access, and affordability as well as shifts in utilization have persisted through the first 3 years of ACA implementation. 10,11 The association of coverage expansion under the ACA with quality of care remains largely unexamined, although 2 initial studies 5,12 have identified an association between Medicaid expansion and patient-reported access to and experiences with chronic care. In addition, among patients at federally funded health centers, Medicaid expansion was associated with improved quality in asthma treatment, Papanicolaou testing, body mass index assessment, and hypertension control, but not differences in other examined measures.…”

Section: Introductionmentioning

confidence: 99%

“…Many of these findings extend to young adults and low-income and middle-income families with children . In the few studies that have examined these trends beyond the first 2 years of coverage expansion, increases in coverage, access, and affordability as well as shifts in utilization have persisted through the first 3 years of ACA implementation …”

Section: Introductionmentioning

confidence: 99%

Association of the Patient Protection and Affordable Care Act With Ambulatory Quality, Patient Experience, Utilization, and Cost, 2014-2016

et al. 2022

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Key Points Question How were ambulatory quality, patient experience, utilization, and cost associated with implementation of the Patient Protection and Affordable Care Act (ACA)? Findings In this nationally representative cross-sectional study of 123 171 individuals, the ACA was associated with more high-value diagnostic and preventive testing, improved patient experience and access, and decreased out-of-pocket expenditures for lower income US individuals. The ACA was not associated with changes to most quality measures, utilization, or the total cost of care. Meaning These findings suggest that policy makers and health system leaders seeking to further improve value should combine insurance expansion with additional policy initiatives to see broader improvements in care.

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Association of Medicaid Expansion Under the Patient Protection and Affordable Care Act With Use of Long-term Care

Abstract: This cohort study uses data from the Health and Retirement Study to examine the association between Patient Protection and Affordable Care Act funded–Medicaid expansion in 2014 and long-term care use among low-income, middle-aged adults newly eligible for Medicaid.

Cited by 16 publications

References 24 publications

A County-level Analysis of the Association Between Medicaid Expansion and Medicare Spending

A County-level Analysis of the Association Between Medicaid Expansion and Medicare Spending

Medicaid Expansion and the Mental Health of Spousal Caregivers

Association of the Patient Protection and Affordable Care Act With Ambulatory Quality, Patient Experience, Utilization, and Cost, 2014-2016

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