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The impact of the Affordable Care Act Medicaid expansion on visit rates for a patient population with diabetes or pre-diabetes in safety net health centers
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2018
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Source: J Am Board Fam Med. 31(6):905-916
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Alternative Title:J Am Board Fam Med
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Personal Author:
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Description:Objective
To: (1) compare clinic-level uninsured, Medicaid-insured, and privately-insured visit rates within and between expansion and non-expansion states prior to and after the ACA Medicaid expansion among the three cohorts of patient populations; and, (2) assess whether there was a change in clinic-level overall, primary care, preventive care visits, and diabetes screening rates in expansion versus non-expansion states from pre- to post-ACA Medicaid expansion.
Methods
Electronic health record data on non-pregnant patients aged 19–64 with ≥1 ambulatory visit between 01/01/2012–12/31/2015 (n=483,912 in expansion states; n=388,466 in non-expansion states) from 198 primary care community health centers (CHCs) were analyzed. Using difference-in-difference methodology, we assessed changes in visit rates pre- versus post-ACA among cohort of patients with diabetes, pre-diabetes, no- diabetes.
Results
Rates of uninsured visits decreased for all cohorts in expansion and non-expansion states. For all cohorts, Medicaid-insured visit rates increased significantly more in expansion compared to non-expansion states, especially among pre-diabetes patients (+71%). In non-expansion states, privately-insured visit rates more than tripled for pre-diabetes cohort and doubled for the diabetes and no-diabetes cohorts. Rates for glycosolated hemoglobin screenings increased in all groups with the largest changes among no diabetes (RR=2.26, 95% CI=1.97–2.56) and pre-diabetes cohorts (RR=2.00, 95% CI=1.80–2.19) in expansion states.
Conclusion
The ACA reduced uninsurance and increased access to preventive care for vulnerable patients, especially those with pre-diabetes. These findings are important to consider when making decisions regarding altering the ACA.
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Pubmed ID:30413546
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Pubmed Central ID:PMC6329010
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