Medicaid Expansion Improved Access to Cardiac Care Without Diminishing Outcomes

MedicalResearch.com Interview with:

Donald Likosky, Ph.D., M.S. Associate Professor Head of the Section of Health Services Research and Quality Department of Cardiac Surgery. University of Michigan

Dr. Likosky

Donald Likosky, Ph.D., M.S.
Associate Professor
Head of the Section of Health Services Research and Quality
Department of Cardiac Surgery.
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Michigan was one of several states to expand Medicaid. Current evaluations of the Michigan Medicaid expansion program have noted increases in primary care services and health risk assessments, but less work has evaluated its role within a specialty service line. There has been concern among some that Medicaid patients, who have traditionally lacked access to preventive services, may be at high risk for poor clinical outcomes if provided increased access to cardiovascular interventions.

Using data from two physician-led quality collaboratives, we evaluated the volume and outcomes of percutaneous coronary interventions and coronary artery bypass grafting 24mos before and 24mos after expansion. We noted large-scale increased access to both percutaneous coronary interventions (44.5% increase) and coronary artery bypass grafting (103.8% increase) among patients with Medicaid insurance. There was a decrease in access for patients with private insurance in both cohorts. Nonetheless, outcomes (clinical and resource utilization) were not adversely impacted by expansion.  Continue reading

Medicaid Expansion Linked To Decreased Infant Mortality, Especially Among African Americans

MedicalResearch.com Interview with:

Chintan Bhatt  MBBS, MPH    (HE/HIM/HIS) Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University Miami Fl 

Dr. Bhatt

Chintan Bhatt  MBBS, MPH    (HE/HIM/HIS)
Department of Health Promotion & Disease Prevention,
Robert Stempel College of Public Health and Social Work,
Florida International University
Miami Fl 

MedicalResearch.com: What is the background for this study?

Response: Women and children are disproportionately affected by the uncertainty around medical health insurance rising in the United States. The Patient Protection and Affordable Care Act was implemented on Jan 1st, 2014, since then the uninsured rate decreased considerably, especially in women aged 18 to 64 years. ACA revised and expanded Medicaid eligibility. Under the law, all U.S. citizens and legal residents with income up to 133% of the poverty line, including adults without dependent children, would qualify for coverage in any state that participated in the Medicaid program. Because of the large proportion of maternal, infant, and child health care and preventive services funded by Medicaid. The purpose of our study was to examine the potential effect of Medicaid expansion on infant mortality rates by comparing infant mortality rate trends in states and Washington D.C. by Medicaid expansion acceptance or decline.

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State ACA Expansions Linked To Large Increase In Prescription Drugs Paid For By Medicaid

MedicalResearch.com Interview with:
Benjamin D. Sommers, MD, PhD
Associate Professor of Health Policy & Economics
Harvard T. H. Chan School of Public Health / Brigham & Women’s Hospital
Boston, MA 02115 and
Kosali Simon PhD
School of Public and Environmental Affairs
Indiana University
Bloomington, IN

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prescription drugs are considered a high value form of medical care, and can be especially difficult for the uninsured to access. The Affordable Care Act’s Medicaid expansion represents an unprecedented expansion of insurance to low-income non-disabled adults, and our study is the first to examine the effects on prescription utilization in detail.

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Primary Care Wait Times For Medicaid Patients Increased Modestly Under Affordable Care Act

MedicalResearch.com Interview with:

Molly Candon, PhD Fellow Leonard Davis Institute of Health Economics, The Wharton School Center for Mental Health Policy and Services Research, Perelman School of Medicine University of Pennsylvania

Dr. Molly Candon

Molly Candon, PhD
Fellow
Leonard Davis Institute of Health Economics, The Wharton School
Center for Mental Health Policy and Services Research, Perelman School of Medicine
University of Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Primary care practices are less likely to schedule appointments with Medicaid patients compared to the privately insured, largely due to lower reimbursement rates for providers. Given the gap in access, concerns have been raised that Medicaid enrollees may struggle to translate their coverage into care. Despite the substantial increase in demand for care resulting from provisions in the Affordable Care Act (ACA), our 10-state audit study recently published in JAMA Internal Medicine finds that primary care appointment availability for new patients with Medicaid increased 5.4 percentage points between 2012 and 2016, while appointment availability for patients with private coverage did not change.

Over the same time period, both Medicaid patients and the privately insured experienced slight increases in wait times.

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ACA Medicare Changes Increased Diagnosis of Early-Stage Colorectal Cancer Among Seniors.

MedicalResearch.com Interview with:

Nengliang “Aaron” Yao PhD Assistant professor Department of Public Health Sciences University of Virginia

Dr. Nengliang Yao

Nengliang “Aaron” Yao PhD
Assistant professor
Department of Public Health Sciences
University of Virginia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The ACA made several changes in Medicare that could increase the use of cancer screening and thus lead to more early cancer diagnoses. This includes waiving patient cost-sharing for screening, waiving patient cost-sharing for one wellness visit per year, and paying bonuses to physicians for doing more work in a primary care setting.

We studied how effective those changes were in facilitating more early diagnoses of breast and colorectal cancers. We found that the changes had no effect on early breast cancer diagnoses (likely because costs and other access barriers for mammograms were already low), but increased the number of early colorectal cancer diagnoses by 8 percent.

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Economic Effects of Medicaid Expansion in Michigan

MedicalResearch.com Interview with:

John Z. Ayanian, MD, MPP</strong> Director of the Institute for Healthcare Policy and Innovation and Alice Hamilton Professor of Medicine University of Michigan

Dr. John Z. Ayanian

John Z. Ayanian, MD, MPP
Director of the Institute for Healthcare Policy and Innovation and
Alice Hamilton Professor of Medicine
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our study assessed the broad economic impact of Medicaid expansion in Michigan – one of several Republican-led states that have chosen to expand Medicaid under the Affordable Care Act. About 600,000 low-income adults in Michigan are covered through the program, known as the Healthy Michigan Plan, which began in April 2014.

Using an economic modeling tool that is also used to advise the state government for fiscal planning, we found that federal funding for the Healthy Michigan Plan is associated with over 30,000 additional jobs, about $2.3 billion in increased personal income in Michigan, and about $150 million in additional state tax revenue annually. One third of the new jobs are in health care, and 85 percent are in the private sector. The state is also saving $235 million annually that it would have spent on other safety net programs if Medicaid had not been expanded.

Thus, the total economic impact of the Healthy Michigan Plan is generating more than enough funds for the state budget to cover the state’s cost of the program from 2017 through 2021. Beginning in 2017, states are required to cover 5 percent of the costs of care for Medicaid expansion enrollees, and the state share of these costs will rise to 10 percent in 2020. The remaining costs are covered by federal funding.

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Choosing Primary Care Physicians Based On Low Office Visit Price Can Save Money for Patients With High Deductible Plans

MedicalResearch.com Interview with:

Dr. Ateev Mehrotra Associate professor, Department of Health Care Policy Harvard Medical School and a  hospitalist at Beth Israel Deaconess Medical Center Boston, Massachusetts

Dr. Ateev Mehrotra

Dr. Ateev Mehrotra MD
Associate professor, Department of Health Care Policy
Harvard Medical School and a
hospitalist at Beth Israel Deaconess Medical Center
Boston, Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: More people in the US are using price transparency websites to shop for care. Some have wondered whether using the information on these websites to choose a doctor will help them actually save money. A relatively small difference in price for visits on the website translated into hundreds of dollars.

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Association Between the 2014 Medicaid Expansion and US Hospital Finances Under Obamacare

MedicalResearch.com Interview with:

Fredric Blavin, PhD The Urban Institute Washington, DC

Dr. Fredric Blavin

Fredric Blavin, PhD
The Urban Institute
Washington, DC 

MedicalResearch.com: What is the background for this study?

Response: The Affordable Care Act expanded Medicaid eligibility to millions of low-income adults. However, the US Supreme Court struck down the mandatory expansion of Medicaid and ruled that each state could choose whether to expand this entitlement program. This choice could affect the financial health of hospitals by decreasing patient volumes and unreimbursed expenses attributable to uninsured patients while increasing revenue from newly covered patients. The impact of Medicaid expansion on hospital profits remains uncertain, particularly for hospitals that receive generous subsidies from state or local governments for providing uncompensated care. 

This analysis focused on the association between Medicaid expansion in 2014 and hospital finances by assessing differences between hospitals in states that expanded Medicaid and those in states that did not expand Medicaid.

MedicalResearch.com: What are the main findings?

Response:  Overall, the 2014 expansion of Medicaid was associated with a decline of $2.8 million in average annual uncompensated care costs per hospital and an increase of $3.2 million in average annual Medicaid revenue per hospital. Medicaid expansion was also significantly associated with improved excess margins (1.1 percentage points) but not with improved operating margins. The estimated associations were also larger in states with high uninsurance rates prior to the implementation of the Affordable Care Act

MedicalResearch.com: What should readers take away from your report?

Response: Hospitals in states that implemented the Medicaid expansion saw significant increases in Medicaid revenue, decreases in uncompensated care costs, and improvements in profit margins, compared with hospitals in states that did not expand Medicaid.

However, the estimates based on profit margin models were less precise and less robust than the other findings. This is not surprising, given the various factors that can influence the overall profitability of hospitals.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Further study is needed to assess the long-term implications of the Medicaid expansion on hospitals’ overall finances. For example, the Affordable Care Act is expected to substantially reduce Medicaid Disproportionate Share Hospital payments in fiscal year 2018; these payments provide additional funding to help cover uncompensated care in qualifying hospitals that serve a large number of Medicaid and uninsured patients. The proposed reductions were developed to help offset some of the federal costs associated with Medicaid expansion, with the expectation that costs would be replaced with Medicaid revenues from newly eligible beneficiaries. However, states that have chosen not to expand Medicaid will experience cuts in this funding source without the offsetting benefit of an influx of new Medicaid patients. This could widen the financial gap between hospitals in states with Medicaid expansion and those in states without expansion. 

MedicalResearch.com: Is there anything else you would like to add?

Response: For states still considering Medicaid expansion, these findings offer evidence that expansion may be associated with improvements in hospitals’ payer mix and overall financial outlook. However, changes in financial outcomes for hospitals in any given state will likely depend on a host of factors, such as the state’s pre-ACA income and coverage distribution, Medicaid eligibility thresholds, Medicaid reimbursement levels, and subsidies paid to hospitals providing uncompensated care. States should take these factors into account when making their Medicaid expansion decision.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Association Between the 2014 Medicaid Expansion and US Hospital Finances
JAMA. 2016;316(14):1475-1483. doi:10.1001/jama.2016.14765
Fredric Blavin, PhD

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Safety-Net Hospitals Show Improvement in Hospital Readmissions, Modifications To Penalty Formula Still Needed

MedicalResearch.com Interview with:

Kathleen Carey, Ph.D. Professor, Department of Health Law, Policy and Management School of Public Health Boston University Boston MA  02118

Dr. Kathleen Carey

Kathleen Carey, Ph.D.
Professor, Department of Health Law, Policy and Management
School of Public Health
Boston University
Boston MA

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The ACA’s Hospital Readmissions Reduction Program (HRRP) imposes Medicare reimbursement penalties on hospitals with readmission rates for certain conditions if they exceed national averages. A number of observers have expressed serious concern over the program’s impact on safety-net hospitals, which serve a high proportion of low income patients who are more likely to be readmitted – often for reasons outside hospital control. Many have argued that the HRRP should adjust for socio-economic status. However, Medicare does not want to lower the standard of quality for these hospitals.

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Health Benefits of Insurance Coverage Under ACA Become More Apparent With Time

MedicalResearch.com Interview with:

Benjamin D. Sommers, MD, PhD Assistant Professor of Health Policy & Economics Harvard T. H. Chan School of Public Health / Brigham & Women's Hospital Boston, MA 02115

Dr. Benjamin D. Sommers

Benjamin D. Sommers, M.D., Ph.D
Assistant Professor of Health Policy & Economics Department of Health Policy & Management
Harvard T.H. Chan School of Public Health
Assistant Professor of Medicine Division of General Medicine & Primary Care
Brigham & Women’s Hospital / Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: More than half of states have expanded Medicaid under the Affordable Care Act, and several states have taken alternative approaches, such as using federal Medicaid funds to purchase private insurance for low-income adults. Our study looks at the effects of these two different approaches – vs. not expanding at all – in three southern states (Kentucky Arkansas, and Texas). What we find is that expanding coverage, whether by Medicaid (Kentucky) or private insurance (Arkansas), leads to significant improvements in access to care, preventive care, quality of care, and self-reported health for low-income adults compared to not expanding (Texas). The benefits of the coverage expansion also took a while to become evident – the first year of expansion (2014) showed some of these changes, but they become much more apparent in the second year (2015).

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