Impacts of the Affordable Care Act on Receipt of Women's Preventive Services in Community Health Centers in Medicaid Expansion and Nonexpansion States

Hatch, Brigit; Hoopes, Megan; Darney, Blair G.; Templeton, Anna; Schmidt, Teresa; Cottrell, Erika

doi:10.1016/j.whi.2020.08.011

Cited by 10 publications

(6 citation statements)

References 38 publications

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“…Enacted in 2010, the Affordable Care Act reduced financial barriers to routine adult vaccination and is associated with improved receipt of influenza vaccination among women. 30 Vaccination coverage in our study was consistently lower than vaccination coverage in a previous study that reported a flat trend in coverage from the 2010-2011 to 2016-2017 influenza season using survey data. 8 The discrepancy is likely the result of differences in methodologies: our estimates did not include vaccinations received outside health insurance plans, whereas survey data may overestimate true coverage because of issues such as social desirability bias and recall bias.…”

Section: Discussioncontrasting

confidence: 69%

Coverage and Timing of Influenza Vaccination Among Privately Insured Pregnant Women in the United States, 2010-2018

2021

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Objective Pregnant women are at increased risk of serious complications from influenza and are recommended to receive an influenza vaccination during pregnancy. The objective of this study was to assess trends, timing patterns, and associated factors of influenza vaccination among pregnant women. Methods We used 2010-2018 MarketScan data on 1 286 749 pregnant women aged 15-49 who were privately insured to examine trends and timing patterns of influenza vaccination coverage. We examined descriptive statistics and identified factors associated with vaccination uptake by using multivariate log-binomial and Cox proportional hazard models. Results In-plan influenza vaccination coverage before delivery increased from 22.0% during the 2010-2011 influenza season to 33.2% during the 2017-2018 influenza season. About two-thirds of vaccinated women received the vaccine in September or October during each influenza season. For women who delivered in September through May, influenza vaccination coverage increased rapidly at the beginning of influenza season and flattened after October. For women who delivered in June through August, influenza vaccination coverage increased gradually until February and flattened thereafter. Most vaccinated women who delivered before January received the vaccine in the third trimester. Increased likelihood of being vaccinated was associated with age 31-40, living in a metropolitan statistical area, living outside the South, enrollment in a consumer-driven or high-deductible health plan, being spouses or dependents of policy holders, and delivery in November through January. Conclusions Despite increases during the past several years, vaccination uptake is still suboptimal, particularly after October. Health care provider education on timing of vaccination and recommendations throughout influenza seasons are needed to improve influenza vaccination coverage among pregnant women.

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Section: Discussioncontrasting

confidence: 69%

Coverage and Timing of Influenza Vaccination Among Privately Insured Pregnant Women in the United States, 2010-2018

2021

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“…In addition to this study, Zwetchkenbaum and Oh [ 46 ] found that the percentage of Medicaid enrollees who received dental care at Rhode Island CHCs also decreased following the ACA Medicaid expansion. However, other recent studies have shown that the Medicaid expansion created opportunities for CHCs to expand Medicaid coverage in CHC patient populations [ 17 ], improve access to preventive medical services [ 16 , 47 ], and expand patient revenue [ 18 ]. One explanation for our findings could be that expansion-state CHCs were infused with younger Medicaid-covered patients requiring less complex surgical services than non-expansion-state CHC patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of the Affordable Care Act Medicaid expansion on oral surgery delivery at community health centers: an observational study

Goldstein

Xu²,

Seiber³

2021

BMC Oral Health

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Background Unmet oral health needs routinely affect low-income communities. Lower-income adults suffer a disproportionate share of dental disease and often cannot access necessary oral surgery services. The Affordable Care Act (ACA) Medicaid expansion created new financial opportunities for community health centers (CHCs) to provide mission-relevant services in low-income areas. However, little is understood in the literature about how the ACA Medicaid expansion impacted oral surgery delivery at CHCs. Using a large sample of CHCs, we examined whether the ACA Medicaid expansion increased the likelihood of oral surgery delivery at expansion-state CHCs compared to non-expansion-state CHCs. Methods Exploiting a natural experiment, we estimated Poisson regression models examining the effects of the Medicaid expansion on the likelihood of oral surgery delivery at expansion-state CHCs relative to non-expansion-state CHCs. We merged data from multiple sources spanning 2012–2017. The analytic sample included 2054 CHC-year observations. Results Compared to the year prior to expansion, expansion-state CHCs were 13.5% less likely than non-expansion-state CHCs to provide additional oral surgery services in 2016 (IRR = 0.865; P = 0.06) and 14.7% less likely in 2017 (IRR = 0.853; P = 0.02). All else equal, and relative to non-expansion-state CHCs, expansion-state CHCs included in the analytic sample were 8.7% less likely to provide oral surgery services in all post-expansion years pooled together (IRR = 0.913; P = 0.01). Conclusions Medicaid expansions can provide CHCs with opportunities to expand their patient revenue and services. However, whether because of known dental treatment capacity limitations, new competition, or coordination with other providers, expansion-state CHCs in our study sample were less likely to provide oral surgery services on the margin relative to non-expansion-state CHCs following Medicaid expansion.

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“…Only a few studies have assessed changes in cardiovascular preventive screenings following the ACA and Medicaid expansion. [7][8][9] Results from these studies showed improvement in glycemic screening but observed no change in blood pressure screening. Among patients with diabetes, there was a significant increase in screening for hemoglobin A1c in both expansion and non-expansion states, with a somewhat greater rise in expansion states.…”

Section: Diabetes and Hypertension Screeningmentioning

confidence: 99%

Diabetes and Hypertension Prevention and Control in Community Health Centers: Impact of the Affordable Care Act

Huguet,

Green,

Larson

et al. 2023

J Prim Care Community Health

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Access to care significantly improved following the implementation of the Patient Protection and Affordable Care Act. Since its implementation, the number of uninsured Americans has significantly decreased. Medicaid expansion played an important role in community health centers, who serve historically marginalized populations, leading to increased clinic revenue, and improved access to care. As the continuous Medicaid enrollment provision established during the pandemic ended, and states have to make decisions about their program eligibility, exploring the impact of Medicaid expansion on the detection, and management of hypertension and diabetes could inform these decisions. We summarized the effect of Medicaid expansion on community health centers and their patients specific to hypertension and diabetes from existing literature. These studies suggest the beneficial impact of the Affordable Care Act and acquiring insurance on diabetes and hypertension disease detection, treatment, and control for patients receiving care in community health centers. Overall, these studies suggest the clear importance of health insurance coverage, and notably insurance stability, on diabetes and hypertension control.

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Impacts of the Affordable Care Act on Receipt of Women's Preventive Services in Community Health Centers in Medicaid Expansion and Nonexpansion States

Cited by 10 publications

References 38 publications

Coverage and Timing of Influenza Vaccination Among Privately Insured Pregnant Women in the United States, 2010-2018

Coverage and Timing of Influenza Vaccination Among Privately Insured Pregnant Women in the United States, 2010-2018

Impact of the Affordable Care Act Medicaid expansion on oral surgery delivery at community health centers: an observational study

Diabetes and Hypertension Prevention and Control in Community Health Centers: Impact of the Affordable Care Act

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