Impact of Medicaid Expansion on Healthcare Utilization

Plain-language summary

The Patient Protection and Affordable Care Act (PPACA) came into law in 2010. Originally, according to the Act, a state would lose its federal Medicaid funding if it did not expand its Medicaid eligibility to include all persons earning below 138% of the federal poverty level on January 1, 2014. However, in a Supreme Court Case in 2012 this was ruled as unconstitutional and Medicaid expansion in 2014 was made optional. Twenty four states and the District of Columbia opted to expand their Medicaid programs on January 1, 2014 and the remaining 26 states opting against it. Section 1115 of the Social Security Act allows states to alter the federal Medicaid requirements to promote the overall state Medicaid program. Among those states that expanded Medicaid Arkansas, Arizona and Iowa adopted approved Section 115 Waivers to expand their Medicaid programs. The variability in the states' decisions regarding Medicaid expansion presented researchers with the opportunity to study the impacts of Medicaid expansion on various facets of health care. There is a growing body of evidence suggesting that implementation of the coverage expansions under the PPACA and Medicaid expansion led to significant decreases in rate of uninsured persons, increase in access to health care and improvements in affordability of healthcare. Along with improving access and affordability of health care, the PPACA aimed at reducing the growth rate of health care expenditures by reducing wasteful use of resources such as preventable inpatient and emergency department (ED) visits. According to previous research, access to primary care and insurance coverage are significantly and negatively associated with experiencing preventable inpatient and ED visits. Historically, racial/ethnic minorities have had lower rates of access to primary care and insurance and higher rates of preventable inpatient and ED visits which might change with implementation of PPACA. Within states that have expanded Medicaid, adopting different methods of expansion may also impact patterns of inpatient and ED utilization and disparities in those. In the current political scenario and looming uncertainty over the future of PPACA and the possibilities of modifying the PPACA it might benefit policy makers to gain knowledge on the early impact of Medicaid expansions and different approaches to expanding Medicaid under the PPACA. This study seeks to determine the impact of Medicaid expansion and different types of Medicaid expansion on overall and preventable inpatient and ED utilization and disparities in those through a three-state comparison between Kentucky, Arkansas and Florida. Another major reform under PPACA was in the area of substance use disorder treatment. Despite the high societal burden exerted by patients with substance use disorders treatment rates among them have been low. The most common reasons cited for the poor access to treatment have been lack of insurance coverage. The PPACA required all insurance plans sold after January 1, 2014 to cover substance use disorder treatments. Additionally, plans were required to cover screening, brief intervention and referral to treatment for substance use disorders. This might potentially lead to changes in treatment rates and sources of payments for substance use disorder treatment. Further, the promotion of integration between substance use disorder treatment and primary care might lead to increased referrals by healthcare professionals to substance use treatment. Thus, in this study we also seek to assess the impact of Medicaid expansion on admission to substance use disorder treatment facilities and changes in sources of payments and rate of health care referrals to those treatment facilities.

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