Medicaid Expansion Produces Long-Term Impact on Insurance Coverage Rates in Community Health Centers.
Medicaid Expansion Produces Long-Term Impact on Insurance Coverage Rates in Community Health Centers.
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DOI：
10.1177/2150131917709403
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发表时间：
2017-10
影响因子：
3.6
通讯作者：
DeVoe JE
中科院分区：
文献类型：
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作者：
Huguet N;Hoopes MJ;Angier H;Marino M;Holderness H;DeVoe JE
背景：了解《平价医疗法案》(ACA)的影响至关重要。这项研究评估了去社区卫生中心(CHC)就诊的患者保险状况的变化，比较了扩大医疗补助范围的州和没有扩大医疗补助范围的州。方法：收集2012年至2015年在9个扩张态和4个非扩张态的412个初级保健中心的875,571名年龄在19岁到之间的≥患者的电子病历数据。我们评估了总的、未参保的、医疗补助参保的和私人参保的初级保健和预防性护理就诊、接种疫苗和订购药物的比率的变化。结果：无保险就诊率在ACA前后有所下降，扩张期(−57%)比非扩张期(−20%)下降幅度更大。在扩张州，医疗补助保险的就诊人数增加了60%，而在非扩张州保持不变。在非扩张状态下，非扩张状态下私人保险的访问量在ACA后高出2.7倍，而扩张状态下没有增加。2015年与2014年相比：在扩张州(−28%)和非扩张州(−19%)，未参保就诊率继续下降，医疗补助参保率没有显著增加，私人参保就诊率在非扩张州增加，但在扩张州没有变化。结论：扩大医疗补助和购买私人保险的补贴可能会增加以前无法获得保险的患者获得医疗保险的机会。
Background:It is crucial to understand the impact of the Affordable Care Act (ACA). This study assesses changes in insurance status of patients visiting community health centers (CHCs) comparing states that expanded Medicaid to those that did not. Methods: Electronic health record data on 875,571 patients aged 19 to 64 years with ≥ 1 visit between 2012 and 2015 in 412 primary care CHCs in 9 expansion and 4 nonexpansion states. We assessed changes in rates of total, uninsured, Medicaid-insured, and privately insured primary care and preventive care visits; immunizations administered, and medications ordered. Results: Rates of uninsured visits decreased pre- to post-ACA, with greater drops in expansion (−57%) versus nonexpansion (−20%) states. Medicaid-insured visits increased 60% in expansion states while remaining unchanged in nonexpansion states. Privately insured visits were 2.7 times higher post-ACA in nonexpansion states with no increase in expansion states. Comparing 2015 with 2014: Uninsured visit rates continued to decrease in expansion (−28%) and nonexpansion states (−19%), Medicaid-insured rates did not significantly increase, and privately insured visits increased in nonexpansion states but did not change in expansion states. Conclusions: Medicaid expansion and subsidies to purchase private coverage likely increased the accessibility of health insurance for patients who had previously not been able to access coverage.