Work in Progress: Immigrant Health Care from the Vantage of Cancer Testing and Screening
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Objective To estimate the relationship between physicians' acceptance of new Medicaid patients and access to health care. Data Sources The National Ambulatory Medical Care Survey ( NAMCS ) Electronic Health Records Survey and the National Health Interview Survey ( NHIS ) 2011/2012. Study Design Linear probability models estimated the relationship between measures of experiences with physician availability among children on Medicaid or the Children's Health Insurance Program ( CHIP ) from the NHIS and state‐level estimates of the percent of primary care physicians accepting new Medicaid patients from the NAMCS , controlling for other factors. Principal Findings Nearly 16 percent of children with a significant health condition or development delay had a doctor's office or clinic indicate that the child's health insurance was not accepted in states with less than 60 percent of physicians accepting new Medicaid patients, compared to less than 4 percent in states with at least 75 percent of physicians accepting new Medicaid patients. Adjusted estimates and estimates for other measures of access to care were similar. Conclusions Measures of experiences with physician availability for children on Medicaid/ CHIP were generally good, though better in states where more primary care physicians accepted new Medicaid patients.
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Unless it is repealed, the Patient Protection and Affordable Care Act of 2010 promises to increase state government obligations for Medicaid by expanding Medicaid eligibility and introducing an individual health insurance mandate for all U.S. citizens and legal permanent residents. Once PPACA becomes fully effective in 2014, the Medicaid benefits of those who become newly eligible and enroll into Medicaid will be almost fully covered by the federal government through 2019, with federal financial support expected to be extended thereafter. But PPACA provides states with no additional federal financial support for new enrollees among those eligible for Medicaid under the old laws. That makes increased state Medicaid spending from higher enrollments by virtually certain as they enroll in Medicaid in response to the individual mandate to purchase health insurance.This study estimates and compares potential increases in Medicaid expenditures from PPACA by the five most populous states: California, Florida, Illinois, New York, and Texas. State Medicaid spending is projected to increase considerably even without PPACA in California, Florida, and Texas, with smaller increases in Illinois and New York. With PPACA, projected spending is actually reduced for California, while spending increases are positive and large for Florida and Texas. Both Illinois and New York have the potential for considerably higher enrollments and increased expenditures.My estimates of the states' PPACA Medicaid burdens are considerably larger than those reported elsewhere, such as in the Kaiser Family Foundation's study, which appears to have used fixed enrollment rates for new- and old-eligibles based on 2007 data. In this study, the individual mandate's impact depends on historical enrollment trends — stronger where enrollment rates were low or declining, weaker where they were high and increasing. Thus, methodological differences may underlie the sizable differences in estimates of states' additional costs from PPACA.
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To estimate how the Affordable Care Act's Medicaid expansions will affect demand for services, we measured ambulatory care utilization among adult patients who gained insurance during Oregon's 2008 Medicaid expansion. Using electronic health record data from 67 community health centers, we assessed pre- and postcoverage utilization among patients who gained insurance, compared with patients continuously insured or uninsured. In comparisons of the pre- and postcoverage periods, mean annual encounters among persons who gained insurance increased 22% to 35%, but declined in the comparison groups. These findings suggest that providers should expect a significant increase in demand among patients who gain Medicaid coverage through the Affordable Care Act.
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PurposeTo assess complementary and alternative medicine (CAM) use in relation to utilization, access, parent's experience with conventional medical care (CM) and CM expenditures for children with and without chronic conditions. MethodsData sources used were the 2007 National Health Interview Survey (NHIS, n=9,417), the linked file of the 2007 NHIS to the 2008 Medical Expenditure Panel Survey (MEPS) (n=2,411) and the 2009/10 National Survey of Children with Special Health Care Needs (NS-CSHCN; n=40,243).Multivariate analyses were used to calculate adjusted odds ratios (AOR), controlling for children's chronic condition and special needs status and demographic characteristics.
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The National Health and Nutrition Examination Survey (NHANES) and the National Health Interview Survey (NHIS) are population-based surveys that have each been linked to administrative data from the Centers for Medicare and Medicaid Services (CMS): the Medicaid Analytic eXtract (MAX) files. These linked data were used to examine, among children under age 18 years, respondent-level concordance between Medicaid or the Children's Health Insurance Program (CHIP) enrollment as reported in each survey (NHANES and NHIS) and as indicated by administrative data from the MAX files. Concordance was defined as having Medicaid/CHIP reported as a health insurance source in the survey questionnaire and having a CMS Medicaid/CHIP administrative record in the same month and year as the interview. Records were also considered concordant if there was no report of Medicaid/CHIP coverage based on the interview response and no match to the CMS administrative records for Medicaid enrollment. Between NHANES and MAX, 88% of observations were concordant with respect to Medicaid or CHIP enrollment, yielding a Kappa of 0.71. Between NHIS and MAX, 89% of observations were concordant with respect to Medicaid or CHIP enrollment, yielding a Kappa of 0.73. These concordance rates provide support for the use of both administrative and NHANES and NHIS as a valuable tool for public health researchers and survey methodologists.
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As part of the Patient Protection and Affordable Care Act, states were given the option of expanding Medicaid coverage to include adults younger than age 65 years with income at or below 138% of the federal poverty level. Although this expansion was intended to provide health care coverage to an estimated 20 million Americans, several studies have shown increased coverage does not equate to increased access to care by specialty providers.We queried the New York Statewide Planning and Research Cooperative System database and identified all patients who underwent the 10 most common elective orthopaedic surgeries from January 1, 2012, through March 31, 2016. Medicaid monthly enrollment for the 4-year study period was obtained from NY Department of Health Medicaid Managed Care Enrollment Reports.Our query identified 700,159 patients who underwent the investigated orthopaedic surgeries. Of these, 60,786 were Medicaid recipients. During the 4-year study period, Medicaid enrollment and the number of procedures reimbursed by Medicaid increased significantly (P < 0.001 for both).Affordable Care Act-supported Medicaid expansion was associated with an increase in Medicaid enrollment and a concomitant increase in the utilization of orthopaedic surgery by Medicaid beneficiaries in New York State.
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An important strategy for increasing health insurance coverage under the Affordable Care Act (ACA) is expanded enrollment in Medicaid, which provides free or very low cost health insurance to low-income people. Over 6 million individuals enrolled in Medicaid or the Children?s Health Insurance Program between October 2013 and April 2014 despite the fact that only about half of the states have expanded Medicaid and the early problems with the federal health insurance website. This brief takes advantage of new data from the Health Reform Monitoring Survey to examine how much of the increase in Medicaid coverage is a net gain in insurance coverage rather than a shift to Medicaid from other coverage, as well as whether there are differences in the patterns of Medicaid changes across states and among different population subgroups.
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This article examines how the Affordable Care Act Medicaid expansions affected the sources of health insurance coverage of undergraduate students in the United States. We show that the Affordable Care Act expansions increased the Medicaid coverage of undergraduate students by 5 to 7 percentage points more in expansion states than in nonexpansion states, resulting in 17% of undergraduate students in expansion states being covered by Medicaid postexpansion (up from 9% prior to the expansion). In contrast, the growth in employer and private direct coverage was 1 to 2 percentage points lower postexpansion for students in expansion states compared with nonexpansion states. Our findings demonstrate that policy efforts to expand Medicaid eligibility have been successful in increasing the Medicaid coverage rates for undergraduate students in the United States, but there is evidence of some crowd out after the expansions-that is, some students substituted their private and employer-sponsored coverage for Medicaid.
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