Preparedness of Americans for the Affordable Care Act

Barcellos, Silvia Helena; Wuppermann, Amelie; Carman, Katherine Grace; Bauhoff, Sebastian; McFadden, Daniel; Kapteyn, Arie; Winter, Joachim; Goldman, Dana P.

doi:10.1073/pnas.1320488111

Cited by 51 publications

(47 citation statements)

References 30 publications

(24 reference statements)

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“…30–33 An American Life Panel survey reported that approximately 30% of persons with an income at or below the federal poverty limit could correctly describe a deductible. 32 These findings, along with the results of our study, support the importance of outreach to Hispanic women and socioeconomically vulnerable populations about reductions in cost sharing for preventive care and other similar value-based changes in insurance policies. Otherwise, such strategies may paradoxically increase disparities if affluent and better-educated patients are more likely to understand and respond to them.…”

Section: Discussionsupporting

confidence: 83%

Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans

et al. 2018

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BACKGROUND The Affordable Care Act (ACA) required most insurers and the Medicare program to eliminate cost sharing for screening mammography. METHODS We conducted a difference-in-differences study of biennial screening mammography among 15,085 women 65 to 74 years of age in 24 Medicare Advantage plans that eliminated cost sharing to provide full coverage for screening mammography, as compared with 52,035 women in 48 matched control plans that had and maintained full coverage. RESULTS In plans that eliminated cost sharing, adjusted rates of biennial screening mammography increased from 59.9% (95% confidence interval [CI], 54.9 to 65.0) in the 2-year period before cost-sharing elimination to 65.4% (95% CI, 61.8 to 69.0) in the 2-year period thereafter. In control plans, the rates of biennial mammography were 73.1% (95% CI, 69.2 to 77.0) and 72.8% (95% CI, 69.7 to 76.0) during the same periods, yielding a difference in differences of 5.7 percentage points (95% CI, 3.0 to 8.4). The difference in differences was 9.8 percentage points (95% CI, 4.5 to 15.2) among women living in the areas with the highest quartile of educational attainment versus 4.3 percentage points (95% CI, 0.2 to 8.4) among women in the lowest quartile. As indicated by the difference-in-differences estimates, after the elimination of cost sharing, the rate of biennial mammography increased by 6.5 percentage points (95% CI, 3.7 to 9.4) for white women and 8.4 percentage points (95% CI, 2.5 to 14.4) for black women but was almost unchanged for Hispanic women (0.4 percentage points; 95% CI, −7.3 to 8.1). CONCLUSIONS The elimination of cost sharing for screening mammography under the ACA was associated with an increase in rates of use of this service among older women for whom screening is recommended. The effect was attenuated among women living in areas with lower educational attainment and was negligible among Hispanic women. (Funded by the National Institute on Aging.)

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Section: Discussionsupporting

confidence: 83%

Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans

et al. 2018

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“…The implications of Affordable Care Act (ACA) for CKD are also substantial given the tremendous role that the nephrology community has played in piloting key ACA demonstration programs (40,41). Although the ACA has dramatically increased the number of low-income nonelderly adults eligible for insurance coverage including Medicaid (42), implementation of the ACA varies by state, which may limit its success (36,43). Public health policies implemented at the state level are likely to affect a larger number of patients.…”

Section: Discussionmentioning

confidence: 99%

Interstate Variation in Receipt of Nephrologist Care in US Patients Approaching ESRD

Gao

Cheung

Greene

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Although multiple factors influence access to nephrologist care in patients with CKD stages 4-5, the geographic determinants within the United States are incompletely understood. In this study, we examined interstate differences in nephrologist care among patients approaching ESRD.Design, setting, participants, & measurements This national, population-based analysis included 373,986 adult patients from the US Renal Data System, who initiated maintenance dialysis between 2005 and 2009. Multilevel logistic regression was used to examine interstate variation in nephrologist care ($12 months before ESRD) for overall and four race-age subpopulations (black or white and older or younger than 65 years). ResultsThe average state-level probability of having received nephrologist care in all states combined was 28.8% (95% confidence interval, 25.2% to 32.7%) overall and was lowest (24.3%) in the younger black subpopulation. Even at these lower levels, state-level probabilities varied considerably across states in overall and subpopulations (all P,0.001). Overall, excluding the states in the upper and lower five percentiles, the remaining states had a probability of receiving care that varied from 18.5% to 41.9%. The lower probability of receiving nephrologist care for blacks than whites among younger patients noted in most states was attenuated in older patients. Geographically, all New England states and most Midwest states had higher than average probability, whereas most Middle Atlantic and Southern states had lower than average probability. After controlling for patient factors, three state-characteristic categories, including general healthcare access measured by percentage of uninsured persons and Medicaid program performance scores, preventive care measured by percentage of receiving recommended preventive care, and socioeconomic status, contributed 55%-66% of interstate variation.Conclusions Patients living in states with better health service and socioeconomic characteristics were more likely to receive predialysis nephrologist care. The reported national black-white difference in nephrologist care was primarily driven by younger black patients being the least likely to receive care.

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“…The uptake of ACA changes are likely to be very challenging, especially for those who live in poverty or near the poverty line and so for racial, ethnic or cultural minority people of color (Gorin, Gehlert, & Washington, 2010;Kimbrough-Melton, 2013;Sommers et al, 2012). Recent national and statewide surveys consistently found prevalent lacks of knowledge about ACA changes, especially among those who might benefit the most from them (Barcellos et al, 2014;Blewett, Lukanen, Call, & Dahlen, 2013;Sinaiko, Ross-Degnan, Soumerai, Lieu, & Galbraith, 2013). In aggregate it seems that the majority of those living in poverty are presently unprepared to effectively navigate the post-Obamacare health care system.…”

Section: Limitations and Implicationsmentioning

confidence: 99%

Breast Cancer among Women Living in Poverty: Better Care in Canada than in the United States

Gorey

Richter

Luginaah

et al. 2015

Social Work Research

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This historical study estimated the protective effects of a universally accessible, single-payer health care system versus a multi-payer system that leaves many uninsured or underinsured by comparing breast cancer care of women living in high poverty neighborhoods in Ontario or California between 1996 and 2011. Women in Canada experienced better care particularly as compared to women who were inadequately insured in the United States. Women in Canada were diagnosed earlier (rate ratio [RR] = 1.12) and enjoyed better access to breast conserving surgery (RR = 1.48), radiation (RR = 1.60) and hormone therapies (RR = 1.78). Women living in high poverty Canadian neighborhoods even experienced shorter waits for surgery (RR = 0.58) and radiation therapy (RR = 0.44) than did such women in the US. Consequently, women in Canada were much more likely to survive longer. Regression analyses indicated that health insurance could explain most of the better care and better outcomes in Canada. Over this study’s 15-year timeframe 31,500 late diagnoses, 94,500 sub-optimum treatment plans and 103,500 early deaths were estimated in high poverty US neighborhoods due to relatively inadequate health insurance coverage. Implications for social work practice, including advocacy for future reforms of US health care are discussed.

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Preparedness of Americans for the Affordable Care Act

Cited by 51 publications

References 30 publications

Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans

Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans

Interstate Variation in Receipt of Nephrologist Care in US Patients Approaching ESRD

Breast Cancer among Women Living in Poverty: Better Care in Canada than in the United States

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