Health Status, Risk Factors, and Medical Conditions Among Persons Enrolled in Medicaid vs Uninsured Low-Income Adults Potentially Eligible for Medicaid Under the Affordable Care Act
Health Status, Risk Factors, and Medical Conditions Among Persons Enrolled in Medicaid vs Uninsured Low-Income Adults Potentially Eligible for Medicaid Under the Affordable Care Act
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DOI：
10.1001/jama.2013.7106
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发表时间：
2013-06-26
影响因子：
120.7
通讯作者：
Long, Sharon K.
中科院分区：
文献类型：
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作者：
Decker, Sandra L.;Kostova, Deliana;Long, Sharon K.
根据《平价医疗法案》（ACA），各州可以将医疗补助资格扩大到几乎所有收入不超过联邦贫困线138%的成年人。不确定性存在的范围内所需的医疗服务为新enrollees.Objective记录的医疗保健需求和健康风险的未投保的成年人谁可以获得医疗补助覆盖下ACA。这些数据将帮助医生，其他临床医生，和国家医疗补助计划准备可能的expands.Design，设置，和患者数据从国家健康和营养检查调查2007-2010年被用来分析健康状况之间的全国代表性样本的1042未投保的成年人年龄在19至64岁，收入不超过138%的联邦贫困线，与471名低收入成年人相比，目前参加了医疗补助计划。主要结果和措施糖尿病，高血压和高胆固醇血症的患病率和控制基于检查和实验室测试，自我报告的健康状况，包括医疗条件和风险因素，如测量肥胖状态。结果与那些已经参加医疗补助计划的人相比，没有保险的成年人不太可能肥胖和久坐不动，也不太可能报告身体、精神或情绪上的限制。他们也不太可能有几种慢性疾病。例如，30.1%（95% CI，26.8%-33.4%）的未投保成年人患有高血压，高胆固醇血症或糖尿病，而参加医疗补助的人则为38.6%（95% CI，32.0%-45.3%）（P= 0.02）。然而，如果他们有这些条件，没有保险的成年人不太可能意识到他们，也不太可能控制他们。例如，80.1%（95%CI，75.2%-85.1%），在这3种疾病中至少有1种的未投保成年人中，至少有1种未受控制的疾病，而63.4%的未投保成年人有1种未受控制的疾病。（95%CI，53.7%-73.1%）。结论和相关性与目前参加医疗补助的成年人相比，没有保险的低收入成年人可能有资格参加ACA下的医疗补助计划，许多慢性病的患病率较低。目前没有保险的慢性病成年人中有很大一部分没有得到良好的疾病控制;基于样本加权的预测表明，这可能代表350万人（95% CI，290万-420万）。这些成年人在参加医疗补助计划后可能需要最初的重症医疗护理。
Importance Under the Affordable Care Act (ACA), states can extend Medicaid eligibility to nearly all adults with income no more than 138% of the federal poverty level. Uncertainty exists regarding the scope of medical services required for new enrollees.Objective To document the health care needs and health risks of uninsured adults who could gain Medicaid coverage under the ACA. These data will help physicians, other clinicians, and state Medicaid programs prepare for the possible expansions.Design, Setting, and Patients Data from the National Health and Nutrition Examination Survey 2007-2010 were used to analyze health conditions among a nationally representative sample of 1042 uninsured adults aged 19 through 64 years with income no more than 138% of the federal poverty level, compared with 471 low-income adults currently enrolled in Medicaid.Main Outcomes and Measures Prevalence and control of diabetes, hypertension, and hypercholesterolemia based on examinations and laboratory tests, measures of self-reported health status including medical conditions, and risk factors such as measured obesity status.Results Compared with those already enrolled in Medicaid, uninsured adults were less likely to be obese and sedentary and less likely to report a physical, mental, or emotional limitation. They also were less likely to have several chronic conditions. For example, 30.1% (95% CI, 26.8%-33.4%) of uninsured adults had hypertension, hypercholesterolemia, or diabetes compared with 38.6% (95% CI, 32.0%-45.3%) of those enrolled in Medicaid (P=.02). However, if they had these conditions, uninsured adults were less likely to be aware of them and less likely to have them controlled. For example, 80.1% (95% CI, 75.2%-85.1%) of the uninsured adults with at least 1 of these 3 conditions had at least 1 uncontrolled condition, compared with 63.4% (95% CI, 53.7%-73.1%) of adults enrolled in Medicaid.Conclusion and Relevance Compared with adults currently enrolled in Medicaid, uninsured low-income adults potentially eligible to enroll in Medicaid under the ACA had a lower prevalence of many chronic conditions. A substantial proportion of currently uninsured adults with chronic conditions did not have good disease control; projections based on sample weighting suggest this may represent 3.5 million persons (95% CI, 2.9 million-4.2 million). These adults may need initial intensive medical care following Medicaid enrollment.