Characteristics of patients with substance use disorder before and after the Affordable Care Act

Abstract

Background: The Affordable Care Act (ACA) offered an unprecedented opportunity to expand insurance coverage to patients with substance use disorders (SUDs). We explored the expectations of key stakeholders for the ACA’s impact on SUD care, and examined how clinical characteristics of newly enrolled patients with SUD in a large healthcare delivery system differed pre- and post- ACA implementation. Methods: In this mixed-methods study, qualitative interviews were conducted with health system leaders to identify themes regarding how the health system prepared for the ACA. Electronic health record data were used to examine demographics, as well as specific SUD, psychiatric, and medical diagnoses in cohorts of pre-ACA (2012, n=6066) vs. post-ACA (2014, n=7099) newly enrolled patients with SUD. Descriptive statistics and logistic regression models were employed to compare pre-ACA and post-ACA measures. Results: Interviewees felt much uncertainty, but anticipated having to care for more SUD patients, who might have greater severity. Quantitative findings affirmed these expectations, with post-ACA SUD patients having higher rates of cannabis and amphetamine use disorders, and more psychiatric and medical conditions, compared to their pre-ACA counterparts. The post-ACA SUD cohort also had more Medicaid patients and greater enrollment in high-deductible plans. Conclusions: Post-ACA, SUD patients had more comorbidities as well as and more financial barriers to care. As federal healthcare policy continues to evolve, with potentially more restrictive coverage criteria, it is essential to continue examining how health systems adapt to changing health policy and its impact on SUD care.

Analysis of Postoperative Outcomes and Economic Behavior Trends of Tympanoplasty and Mastoidectomy With Expansion of High Deductible Health Plans

“…Although the data do not describe monthly increases in ear surgeries like what was previously done for orthopedic surgeries, this work compares the beginning and end of the year differences (1). Barring Medicare plans, higher deductible plans became a common feature when the ACA was established, so patients became more likely to wait to have ear surgery once their deductible was met in the last few months of the fiscal year (1,4,(6)(7)(8)(9)18). The increased volume of ear surgeries toward the end of the year contributes to a flood of cases and a year-end-rush.…”

Health care utilization and HIV clinical outcomes following Affordable Care Act implementation in California: A longitudinal study

“…KPNC pharmacy databases include codes that indicate whether the ll was subsidized by ADAP; enrollment was assessed from HIV prescription lls in 2014. Deductible limits were classi ed into 3 levels (none, $1-$999 and >= $1000), as in prior studies within KPNC [23,24]. Since these may change over time, for analyses we used the values that were applicable at enrollment and every six months thereafter.…”

Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study

“…KPNC pharmacy databases include codes that indicate whether the fill was subsidized by ADAP; enrollment was assessed from HIV prescription fills in 2014. Deductible limits were classified into 3 levels (none, $1–$999 and > = $1000), as in prior studies within KPNC [ 25 , 26 ]. Since these may change over time, for analyses we used the values that were applicable at enrollment and every 6 months thereafter.…”