The KFF COVID-19 Vaccine Monitor is an ongoing research project tracking the public’s attitudes and experiences with COVID-19 vaccinations. Using a combination of surveys and qualitative research, this project tracks the dynamic nature of public opinion as vaccine development and distribution unfold, including vaccine confidence and acceptance, information needs, trusted messengers and messages, as well as the public’s experiences with vaccination.

Key Findings

• The latest KFF COVID-19 Vaccine Monitor report highlights the disproportionate toll the pandemic has taken on Hispanic adults in the United States. Hispanic adults, particularly those who mainly speak Spanish, were born outside the U.S., or who have lower incomes, are more likely than White adults to say someone close to them has gotten sick from COVID-19 or that they worry about someone in their family getting sick and more likely to say the pandemic has negatively affected their financial situation. At a time when many are facing growing financial needs, one in ten (11%) Hispanic adults, rising to one-quarter (26%) of those who are potentially undocumented, say there was a time in the past 3 years when they or a family member decided not to apply for or stopped participating in a government assistance program that helps with food, housing, or health care because they were afraid it might negatively affect their or a family member’s immigration status.
• Among those who have not yet been vaccinated, Hispanic adults are about twice as likely as White adults to say they want to get a COVID-19 vaccine as soon as possible, indicating an opportunity for more focused outreach and information efforts. While nearly half (47%) of Hispanic adults report having received at least one dose of a COVID-19 vaccine, one-third of unvaccinated Hispanic adults say they want a vaccine as soon as possible, about twice the share as among unvaccinated Black and White adults. By contrast, unvaccinated Hispanic adults are half as likely as unvaccinated White adults to say they will “definitely not” get the vaccine (17% vs. 34%).
• Large shares of Hispanic adults – particularly those with lower incomes, the uninsured, and those who are potentially undocumented – express concerns that reflect access-related barriers to vaccination. Compared to White adults, larger shares of unvaccinated Hispanic adults say they are concerned about missing work due to vaccine side effects, that they might have to pay out of pocket for the vaccine (despite it being free), not being able to get the vaccine from a trusted place, or having difficulty traveling to a vaccination site. Among Hispanic adults, the shares expressing many of these concerns are even greater among those with lower incomes, the uninsured, and those who are potentially undocumented.
• Requests for documentation may pose a barrier to vaccination for some Hispanic adults, particularly those who live in immigrant families. Over half of Hispanic adults (56%) who have been vaccinated say they were asked to provide a government-issued identification when they received their vaccine and 15% say they were asked to provide a Social Security number. While eligibility to receive a COVID-19 vaccine in the U.S. is not linked to immigration status, requests for these types of information or documents may be a deterrent for some Hispanic adults, particularly those in immigrant families. In fact, about four in ten unvaccinated Hispanic adults (rising to 58% of those who are potentially undocumented) say they are concerned that they may be required to provide a government-issued identification or Social Security number to get vaccinated, and about one third (rising to 63% of the potentially undocumented) are concerned that getting the vaccine may negatively affect their own or a family member’s immigration status.
• There are gaps in information about who is eligible for the vaccine and how to get it among the Hispanic population. Large shares of unvaccinated Hispanic adults, particularly those who are potentially undocumented, are unsure if they are eligible to get a vaccine or say they don’t have enough information about when or where to get one. At least half are unaware that the vaccines are free for all U.S. residents and that all adults are eligible regardless of immigration status.
• Making COVID-19 vaccines available in more convenient locations, providing paid time off to recover from side efforts, or requiring vaccination for travel may be more effective at encouraging vaccine uptake among Hispanic adults compared to others. Almost half of unvaccinated Hispanic adults who are not yet ready to get the vaccine right away say they’d be more likely to get vaccinated if the vaccine was offered at a place they normally go for care, and four in ten of those with jobs say they’d be more likely to get it if their employer arranged for it to be delivered at their workplace, both higher than the shares of White adults who say the same. Over half of employed, unvaccinated Hispanic adults who are not yet ready to get the vaccine say they’d be more inclined to get it if their employer gave them paid time off to get vaccinated and recover from side effects. Requiring the vaccine for airline or international travel may be particularly effective at encouraging foreign-born Hispanics the vaccine, with about six in ten saying such requirements would make them more likely to get vaccinated.

Introduction

The COVID-19 pandemic has taken a stark disproportionate toll on people of color, including the Hispanic population. Hispanic people have faced increased risk of exposure to the virus as many are employed in essential jobs that cannot be done from home and live in larger, multigenerational households. Reflecting these increased risks, Hispanic people have suffered higher rates of COVID-19 infection, hospitalization, and death compared to their White counterparts. Despite being harder hit by the pandemic, Hispanic people have been less likely than White people to receive a COVID-19 vaccine so far. These disparate impacts of the COVID-19 pandemic have exposed and exacerbated longstanding underlying disparities in health and health care facing Hispanic people. Prior to the pandemic, these disparities had already been compounded by immigration policies implemented during the Trump administration that increased fears among immigrant families and made some more reluctant to access programs and services, including health coverage and health care. Although the Biden administration has since reversed many of these policies, they may continue to have lingering effects among families.

This report from the KFF COVID-19 Vaccine Monitor is based on interviews with 778 Hispanic adults in the U.S., including 334 conducted in Spanish and 408 with adults born outside the U.S., including 185 who indicated that they do not have lawful permanent resident status (referred to in this report as “potentially undocumented”).¹  It provides insights into how Hispanic adults have been affected by the COVID-19 pandemic and their access, information, and experiences with COVID-19 vaccinations. Moreover, it illustrates the varied experiences within the Hispanic population, including describing the experiences of Hispanic immigrants, for whom data remain limited. Throughout this report, Hispanic adults include people of any race, other groups (i.e., White and Black adults) are non-Hispanic.

COVID-19 Impacts on Hispanic Adults in the U.S.

The survey findings reveal that Hispanic adults have substantial fears about getting sick from coronavirus, and that many have close connections to people who have gotten sick or died from COVID-19. They also highlight the widespread negative financial impacts of the pandemic for Hispanic adults. In addition, they provide insight into how immigration-related fears may be affecting Hispanic adults’ willingness to participate in assistance programs for food, housing, and health care, at a time when many have growing needs due to the financial impacts of the pandemic.

About two-thirds of Hispanic adults say they are worried that they or someone in their family will get sick from coronavirus, including 41% who say they are very worried. The share saying they are very worried is higher among Hispanic adults than among Black adults (30%) and is four times the rate among White adults (10%). Worries about getting sick from coronavirus are even more prevalent among Hispanic immigrants, particularly those without permanent resident status. Seven in ten (69%) of potentially undocumented Hispanic adults say they are very worried about themselves or a family member getting sick from COVID-19 as are over half (57%) of foreign-born Hispanic adults with permanent resident status. Among U.S.-born Hispanic adults (who are much younger on average than their foreign-born counterparts), one quarter (24%) express this level of worry. There also are stark differences in levels of concern among Hispanic adults by language spoken and household income, with nearly three in four (73%) of Hispanic adults who completed the survey in Spanish and over half (53%) of those in lower income households reporting being very worried about getting sick.

This higher level of worry is not unfounded, as Hispanic adults are more likely than White adults to report close connections to someone who has gotten sick or died from coronavirus. Nearly three in ten (28%) of Hispanic adults say they or someone in their household has tested positive for coronavirus, higher than the shares of Black (21%) and White adults (18%). This share rises among Hispanic adults born outside the United States, including 40% of the potentially undocumented. About four in ten (38%) Hispanic adults say a close friend or family member has died from coronavirus, similar to the 34% among Black adults and higher than the 18% among White adults. There were no major differences in the likelihood of having a close friend or family member die by immigration status.

The pandemic has also taken a disproportionate financial toll on Hispanic families in the United States. About half (48%) of Hispanic adults say the pandemic has had a negative effect on their personal financial situation, higher than the share of White adults who say the same (36%). Among those with lower household incomes (under $40,000 per year), 56% of Hispanic adults say their financial status has been negatively affected by the pandemic, higher than the shares among lower-income Black or White adults (42% each). There were no major differences in the likelihood of reporting negative financial effects by immigration status. However, a 55% majority of Hispanic adults who completed the survey in Spanish say their financial situation has been negatively impacted by the pandemic, higher than the four in ten (43%) of English-speaking Hispanic adults who report being negatively affected.

Some Hispanic adults, particularly those who are potentially undocumented, report that they have avoided seeking assistance for food, housing, and/or health care due to immigration-related fears. The Trump administration implemented a range of immigration policy changes, including changes to public charge policy, that increased fears among immigrant families and made some more reluctant to access programs and services, including health coverage and care. While the Biden administration has since reversed many of these policies, they may continue to have lingering effects among families at a time when many are facing growing needs due to the pandemic.

Overall, one in ten Hispanic adults (11%), say there was a time in the past 3 years when they or a family member decided not to apply for or stopped participating in a government assistance program because they were afraid it might negatively affect their or a family member’s immigration status. Across Hispanic adults overall, 6 percent say they did not apply for or stopped participating a program to help with food, 4 percent say assistance for housing, and 3 percent say a health care program.

The share saying they or a family member did not apply for or stopped participating in a program in the past 3 years due to immigration-related fears increased rises to 26% among potentially undocumented Hispanic adults. Among potentially undocumented Hispanic adults, 21% say they did not apply for or stopped participating a program to help their family with food, 12 percent say assistance for housing, and 11 percent say a health care program. While undocumented immigrants generally are not eligible for any federally-funded assistance, many live in mixed immigration status families, including other family members such as U.S.-born citizen children, who may qualify for assistance.

COVID-19 Vaccination Intentions Among Hispanic Adults

Nearly half (47%) of Hispanic adults say they have already received at least one dose of a COVID-19 vaccine and another 17% say they intend to get one as soon as they can. The share of Hispanic adults who say they’ve received at least one dose of the vaccine is lower than the share among White adults (60%), while a larger share of Hispanic adults compared to White adults say they will “wait and see” how the vaccine is working for other people before getting vaccinated themselves (18% vs. 13%). Nearly one in five (17%) Hispanic adults report that they have not yet been vaccinated but want to get one as soon as possible, higher than the shares among White adults (6%) and Black adults (9%).

Among those who have not yet been vaccinated, Hispanic adults are twice as likely as White adults to say they want to get a COVID-19 vaccine as soon as they can, making them a key target for outreach and information. Looking just at those adults who have not yet received a COVID-19 vaccine, one-third of Hispanic adults say they want to get one as soon as they can compared to 16% of White adults and 17% of Black adults. By contrast, larger shares of unvaccinated White and Black adults compared to Hispanic adults say they will definitely not get a COVID-19 vaccine (34%, 26%, and 17%, respectively).

Some groups of Hispanic adults are more likely to say they have not yet gotten the vaccine but want to get one as soon as possible, suggesting they are particularly likely to face access barriers to getting the vaccine. For example, three in ten (31%) of potentially undocumented Hispanic adults report having gotten a COVID-19 vaccine, and nearly four in ten (37%) want one as soon as possible but haven’t yet gotten one. This finding is similar for uninsured nonelderly Hispanic adults, with about three in ten (29%) of this group reporting receiving the vaccine and another 30% wanting one as soon as possible. Adults who completed the survey in Spanish are also more likely than English speaking adults to say they want a vaccine as soon as possible, but this largely reflects a higher share of English-speaking Hispanic adults saying that they do not plan to get the vaccine.

Among Hispanic adults, divides in COVID-19 vaccination intention by age, education, and partisanship mirror those seen in the general population. Large majorities of Hispanic adults ages 50 and over say they’ve already gotten at least one dose of the vaccine or will do so as soon as possible (85% of those ages 50-64 and 88% of those ages 65 and over). By contrast, larger shares of younger Hispanic adults say they want to wait and see how the vaccine is working (20% of those ages 30-49 and 31% of those ages 18-29). Similarly, Hispanic adults who identify as Democrats or lean that way are much more likely than those who identify or lean Republican to say they have either gotten a vaccine or will do so as soon as they can, while Republicans are more likely to say they will definitely not get vaccinated. Hispanic adults with a college degree are more likely than those with lower levels of education to say they’ve already gotten a COVID-19 vaccine (61% vs. 45%), while those who are not college graduates are more likely to say they have not been vaccinated but want to do so as soon as possible (18% vs. 10%), suggesting possible access barriers for this less-educated group, similar to the groups mentioned above.

Hispanic Adults’ Experiences Getting a COVID-19 Vaccine

Among those who report receiving a COVID-19 vaccine, Hispanic adults are more likely than White and Black adults to report getting their vaccine through a community health clinic. The most common place people report receiving a COVID-19 vaccine across race and ethnicity groups is a large vaccination site. At least one-third of those who have received at least one dose of a vaccine reporting receiving it there (35% of vaccinated Hispanic adults, 37% of Black adults, and 35% of White adults). Consistent with other analysis showing community health centers are vaccinating larger shares of people of color, particularly Hispanic people, over one in five (22%) vaccinated Hispanic adults reported getting their vaccine at a community health clinic, twice the share of White (11%) and Black (10%) vaccinated adults who report the same. Among Hispanic adults, 30% of those who completed the interview in Spanish say they got vaccinated at a community health clinic compared to 17% of those who completed the interview in English. There were no significant differences in the share of Hispanic adults getting vaccinated at a community health clinic by immigration status or income.

Hispanic adults are less likely than White adults to report signing up for a vaccine appointment online. Among those who have gotten a vaccine or have tried to get an appointment, about half of Hispanic adults (48%) either signed up or tried to do so online compared to nearly six in ten White adults (58%). A quarter (25%) of Hispanic adults say they signed up or tried to sign up by phone, and another 16% scheduled or sought to schedule an appointment in person.

Many Hispanic adults report being asked for certain types of information or documentation when they signed up for or received a vaccine that may pose barriers to getting the vaccine for some. The COVID-19 vaccines are available for free regardless of insurance status. Some vaccine providers request health insurance information from people receiving the vaccine in order to bill for the cost of administering the vaccine, which may lead some people to be confused about whether uninsured people can get the vaccine or if they have to pay to receive one. The federal government has also clarified that vaccines are available to individuals regardless of immigration status. Despite this, requests for information and/or documentation to provide proof of identity or residency may vary across states, localities, and vaccination providers. For example, in some cases, individuals are being requested to provide government-issued identification or a Social Security number, while others provide a range of options to prove identity or residency, including self-attestation, and specify that a Social Security number is not required.

Among all Hispanic adults who made or attempted to make an appointment to receive a vaccine, about a third (32%) report being asked to provide health insurance information when making an appointment. Four in ten (42%) say they were asked to provide a government-issued identification and 14% say they were asked to provide a Social Security number. Among those who have been vaccinated for COVID-19, over half (56%) say they were asked for their ID at the vaccination site, 23% were asked for insurance information and 15% report being asked to provide a Social Security number.

Potential Barriers To COVID-19 Vaccination Among Hispanic Adults

Hispanic adults who have not yet been vaccinated for COVID-19 are more likely than White adults to express concerns that reflect access-related barriers to vaccination. Although potential side effects and vaccine safety are the top-ranked concerns among Hispanic adults who have not yet been vaccinated for COVID-19, many also report concerns related to potential challenges getting the vaccine. Among unvaccinated Hispanic adults, nearly two-thirds (64%) are concerned about missing work due to side effects, over half (52%) are worried they might have to pay out of pocket for the vaccine, and nearly half are concerned they won’t be able to get the vaccine from a place they trust (49%), shares that are significantly larger than their White counterparts.

Notably, among Hispanic adults who say they have not yet been vaccinated but want to do so right away, six in ten are concerned that they won’t be able to get the vaccine from a place they trust (61%) or that they might have to pay an out-of-pocket cost to get the vaccine (59%) and half (52%) are concerned about missing work due to vaccine side effects, highlighting that access remains a barrier even for those in the most eager group.

Because the Hispanic population includes higher shares of noncitizens compared to other groups, immigration-related concerns may also particularly affect this population. Four in ten unvaccinated Hispanic adults (39%) are concerned they might be required to provide a Social Security number or government-issued identification in order to get vaccinated, and just over a third (35%) are concerned that by getting the COVID-19 vaccine they might negatively affect their own or a family member’s immigration status.

Among unvaccinated Hispanic adults, those who are potentially undocumented, those without health insurance, and those with lower household incomes are more likely to express potential access-related barriers or immigration-related concerns to vaccination. The top access-related concern across these groups is that they might have to miss work due to side effects. Not surprisingly, potentially undocumented Hispanic adults are particularly concerned they may need to provide a Social Security number or government issued ID to get the vaccine (58%), and nearly two thirds (63%) are concerned getting the vaccine might negatively affect their or a family member’s immigration status.

In addition, unvaccinated Hispanic adults who are uninsured are more likely than those who have health insurance to say they are concerned about not being able to get the vaccine from a place they trust, being required to provide a Social Security number or government-issued ID, or negatively impacting their own or a family member’s immigration status.

Compared to their higher-income counterparts, unvaccinated Hispanic adults with incomes under $40,000 a year are more likely to say they are concerned about missing work due to COVID-19 vaccine side effects, having to pay an out-of-pocket cost to get vaccinated, negatively affecting someone’s immigration status, and having difficulty traveling to a vaccination site.

Strategies that address access-related concerns may be particularly effective for increasing enthusiasm to get the COVID-19 vaccine among Hispanic adults. For example, nearly half of Hispanic adults who have not gotten the vaccine and are not ready to get it right away (46%, rising to 64% among those born outside the U.S.) say they’d be more likely to get a COVID-19 vaccine if it was offered to them at a place they normally go to health care, compared to 23% of White adults. Four in ten Hispanic adults in this group (39%, rising to 49% of foreign-born) would be more likely to get vaccinated if they only needed to get one dose compared to a quarter (25%) of White adults. Over half (54%) of employed Hispanic adults who are not yet ready to get the vaccine say they would be more likely to get it if their employer gave them paid time off to recover from side effects compared to 19% of employed White adults. In addition, four in ten (38%) employed Hispanic adults in this group say they would be more likely to get vaccinated if their employer arranged for a medical provider to administer the vaccine at their workplace, compared to 14% of their White counterparts.

Certain financial and travel-related incentives may also be particularly effective in increasing vaccine enthusiasm among Hispanic adults, especially those born outside the United States. Over four in ten (41%) of Hispanic adults (including 63% of those born outside the US) who are not yet ready to get the vaccine say they’d be more likely to get vaccinated if it was required for international travel compared to 17% of White adults. There are also differences in responses to employer incentives to get vaccinated. Nearly four in ten (38%) of employed Hispanic adults who are not yet ready to get the vaccine said they would be more likely to get it if their employer offered them a $200 incentive to get vaccinated, versus 22% of their White counterparts.

COVID-19 Vaccine Information Gaps and Needs

Increased outreach and education about how, where, and when to the vaccine may also facilitate increased vaccinations among the Hispanic population. Increasing awareness that the vaccine is free regardless of insurance status and available to all individuals regardless of immigration status may also encourage vaccination among those concerned about costs or potential negative immigration-related consequences.

Larger shares of Hispanic adults compared to White adults report lacking information about when and how to the get the vaccine, with particularly large information gaps among those who are foreign-born, who are Spanish-speakers, and who have lower incomes. Despite broadened eligibility for vaccines across states, 42% of unvaccinated Hispanic adults (compared to 26% of unvaccinated White adults) say they are unsure if they are eligible to receive the vaccine in their state, with this share rising to 57% among the potentially undocumented, 49% among Spanish speakers, and 47% with household incomes below $40,000. Similarly, 29% of Hispanic adults overall say they don’t have enough information about where to get a vaccine, including higher shares of potentially undocumented (43%) and Spanish-speaking (38%) Hispanic adults. Nearly half of all unvaccinated Hispanic adults (45%) say they lack information about when they can get a vaccine, and this share rises to more than half among those who are potentially undocumented (58%), those who completed the interview in Spanish (56%), and those with household incomes under $40,000 a year (54%).

Most Hispanic adults who completed the survey interview in Spanish (68%) say it is either “very easy” or “somewhat easy” to find COVID-19 vaccine information in Spanish, but 27% say it is at least “somewhat difficult.” Similarly, most Spanish speakers say they were able to access information or communicate in their preferred language when making their vaccine appointment (68%) and when getting their vaccine (77%), but some say they were not able to communicate in their preferred language when making an appointment (26%) or getting the vaccine (22%).

There are gaps in knowledge that the vaccine is available for free among unvaccinated Hispanic adults. Roughly half (46%) of unvaccinated Hispanic adults know that the vaccine is available for free even for those without health insurance while 9% believe this is not the case and four in ten (43%) are not sure. More than half (54%) of unvaccinated Hispanic women know that vaccines are available for free while four in ten (39%) of Hispanic men are also aware of this. Knowledge that the vaccine is available for free is higher among unvaccinated Hispanics who completed the survey in Spanish (60%) versus those who completed it in English (37%). Among Hispanic adults ages 18-64 who have not yet gotten vaccinated, similar shares of those with and without health insurance are aware that the vaccine is available regardless of health insurance status (47% and 44%, respectively).

There also are gaps in knowledge about the vaccine being available to all people regardless of immigration status among unvaccinated Hispanic adults. The federal government has clarified that all people are eligible to receive the COVID-19 vaccine regardless of immigration status. Four in ten unvaccinated Hispanic adults (42%) are aware that all adults living in the U.S. are eligible to receive a vaccine regardless of their immigration status, larger than the share of unvaccinated Black adults (15%) and White adults (27%) who know this is true. Yet, 9% of Hispanic adults believe it is not the case that all adults are eligible to get the vaccine regardless of immigration status and nearly half (48%) are not sure. Among unvaccinated Hispanic adults, a larger share of those who completed the survey in Spanish know that the vaccine is available regardless of immigration status compared to those who completed the survey in English (55% vs. 33%). Hispanic adults who are potentially undocumented are somewhat more likely than those born in the U.S. to incorrectly say it is not true that U.S. residents are eligible to get the vaccine regardless of immigration status (14% vs. 5%), while those born in the U.S. are more likely to say they’re not sure (56% vs. 35%).

Implications

Together these findings suggest that addressing access barriers and providing information through outreach and education efforts will be key for closing ongoing racial disparities in COVID-19 vaccinations for Hispanic adults. They indicate that increasing access to paid time off to get and recover from any side effects from the vaccine and making vaccines easily accessible through trusted sites of care and workplaces may facilitate uptake of vaccinations among Hispanic adults. Moreover, they highlight continued needs for outreach and education efforts within the Hispanic community to communicate how and where to get the vaccine and to clarify that the vaccines are free regardless of insurance status, that they are available to all people regardless of immigration status, and that receiving a vaccine will not negatively affect an individual’s current or future immigration status. The findings also reinforce why prioritizing equity in COVID-19 vaccinations is key, given the disproportionate health and economic impacts of the pandemic for Hispanic families and other people of color.

This KFF COVID-19 Vaccine Monitor was designed and analyzed by public opinion researchers at the Kaiser Family Foundation (KFF). The survey was conducted April 15-29, 2021, among a nationally representative random digit dial telephone sample of 2,097 adults ages 18 and older (including interviews from 778 Hispanic adults and 507 non-Hispanic Black adults), living in the United States, including Alaska and Hawaii (note: persons without a telephone could not be included in the random selection process). Phone numbers used for this study were randomly generated from cell phone and landline sampling frames, with an overlapping frame design, and disproportionate stratification aimed at reaching Hispanic and non-Hispanic Black respondents. Stratification was based on incidence of the race/ethnicity subgroups within each frame. Specifically, the cell phone frame was stratified as: (1) High Hispanic: Cell phone numbers associated with rate centers from counties where at least 35% of the population is Hispanic; (2) High Black: Cell phone numbers associated with remaining rate centers from counties where at least 35% of the population is non-Hispanic Black; (3) Else: numbers from all remaining rate centers. The landline frame was stratified as: (1) High Black: landline exchanges associated with Census block groups where at least 35% of the population is Black; (2) Else: all -remaining landline exchanges. The sample also included 163 respondents reached by calling back respondents that had previously completed an interview on the KFF Tracking poll at least nine months ago. Another 358 interviews were completed with respondents who had previously completed an interview on the SSRS Omnibus poll (and other RDD polls) and identified as Hispanic (n = 221; including 67 in Spanish and 40 who screened as potentially undocumented) or non-Hispanic Black (n=137). An oversample of potentially undocumented Hispanic (n=32) respondents was reached by dialing prepaid cell phone number in the High Hispanic stratum and screening for potential residency status. Computer-assisted telephone interviews conducted by landline (298) and cell phone (1,799, including 1,411 who had no landline telephone) were carried out in English and Spanish by SSRS of Glen Mills, PA. To efficiently obtain a sample of lower-income and non-White respondents, the sample also included an oversample of prepaid (pay-as-you-go) telephone numbers (25% of the cell phone sample consisted of prepaid numbers) Both the random digit dial landline and cell phone samples were provided by Marketing Systems Group (MSG). For the landline sample, respondents were selected by asking for the youngest adult male or female currently at home based on a random rotation. If no one of that gender was available, interviewers asked to speak with the youngest adult of the opposite gender. For the cell phone sample, interviews were conducted with the adult who answered the phone. KFF paid for all costs associated with the survey.

The combined landline and cell phone sample was weighted to balance the sample demographics to match estimates for the national population using data from the Census Bureau’s 2019 U.S. American Community Survey (ACS), on sex, age, education, race, Hispanic origin, and region, within race-groups, along with data from the 2010 Census on population density. The sample was also weighted to match current patterns of telephone use using data from the January- June 2020 National Health Interview Survey The weight takes into account the fact that respondents with both a landline and cell phone have a higher probability of selection in the combined sample and also adjusts for the household size for the landline sample, and design modifications, namely, the oversampling of potentially undocumented respondents and of prepaid cell phone numbers, as well as the likelihood of non-response for the re-contacted sample. All statistical tests of significance account for the effect of weighting.

The margin of sampling error including the design effect for the full sample is plus or minus 3 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available by request. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll. Kaiser Family Foundation public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.

This work was supported in part by grants from the Chan Zuckerberg Initiative DAF (an advised fund of Silicon Valley Community Foundation), the Ford Foundation, and the Molina Family Foundation. We value our funders. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.

1. The survey used questions to determine the likely immigration status of respondents by asking those who were born outside the U.S. whether they were a permanent resident (i.e. had a green card) when they came to the U.S. or if their status had been changed to permanent resident since arriving. In the current survey, 18 percent of Hispanic adults said they have not been granted permanent resident status, indicating that they are likely to be undocumented immigrants, although this group may also include a small number of temporary lawful residents. ↩︎

The new financial incentive for expansion in the American Rescue Plan Act (ARPA) of 2021 has reignited debate on Medicaid expansion under the Affordable Care Act (ACA) in the twelve states that have not adopted the expansion. Further, the coronavirus pandemic has adversely affected health outcomes (as evidenced by suppressed health care utilization and increased excess mortality) and economic wellbeing. While Medicaid has served as a coverage safety net during the pandemic and resulting economic crisis, coverage options for many low-income adults are limited in non-expansion states.

This literature review provides context for these expansion debates by summarizing evidence from nearly 200 studies published between February 2020 and March 2021 on the impact of state Medicaid expansions under the ACA. This review builds on an earlier report (examining over 400 studies) concluding that expansion is linked to gains in coverage; improvements in access, financial security, and some measures of health status/outcomes; and economic benefits for states and providers (see Appendix A for figures summarizing study findings from the combined 601 studies from both reviews).

This recent body of research finds positive effects of expansion across a range of increasingly complex and specific categories. Accordingly, this report highlights study findings across multiple key themes of interest:

• Mortality, overall and associated with specific conditions.
• Cancer, chronic disease, and disabilities, including conditions considered risk factors for COVID-19.
• Sexual and reproductive health, including maternal and infant health, postpartum insurance coverage, access to contraception, and HIV/AIDS screening and outcomes.
• Behavioral health, including substance use disorder and mental health.
• Economic impacts on states and providers, including effects on state economies and on hospital financial performance.
• Disparities by race/ethnicity, socioeconomic status, and other categories.
• Social determinants of health including access for rural areas, economic and educational outcomes, and outcomes for justice-involved and homeless individuals.

Studies included in this review may include multiple findings across multiple categories. Additionally, this report does not attempt to summarize all findings across all studies but instead aims to highlight conclusions across themes. A small number of studies reviewed and included in the appendices to this review did not have findings that fall into the thematic categories and thus are not cited in the text of this report.

Themes in Recent Research

Several key themes emerge from recent literature investigating the effects of Medicaid expansion (Figure 1). In contrast to earlier research, which largely focused on the impacts of Medicaid expansion for the general population or for low-income populations, recent research has increasingly focused on outcomes for specific populations, such as people with cancer or behavioral health needs. Recent research has also focused on specific outcomes such as mortality and social determinants of health. Although overall findings across these themes generally show positive effects of Medicaid expansion, a smaller number of studies find no impact of expansion on specific outcomes for specific populations; however, very few studies suggest any negative effects.

Many studies published between February 2020 and March 2021 and cited throughout this report have findings across multiple of these themes and are thus cited in multiple sections. Additionally, many studies on expansion published prior to February 2020 also have findings related to these themes but are not cited in this report; however, these can be found cited in an earlier literature review and are also included in the Bibliography and Appendices to this report.

Mortality

A growing body of research finds that Medicaid expansion has improved overall mortality rates as well as mortality rates associated with some specific health conditions. These findings are consistent with earlier research identifying that expansion contributed to declines in overall and some specific mortality rates, but had no effect on mortality rates associated with other specific conditions.

• Overall mortality. A 2020 national study found that expansion was associated with a significant 3.6% decrease in all-cause mortality, the majority of which was accounted for by a significant 1.93% decrease in health care amenable mortality. Another study found that expansion was associated with reductions in health care amenable mortality and in mortality not due to drug overdose.^1 ,2 
• Mortality associated with specific health conditions. A larger number of studies consider the impact of expansion on mortality rates for particular populations or associated with certain health conditions:
  • Studies find that expansion was associated with significant declines in mortality related to certain specific conditions, in some instances limited to certain subgroups. These findings include decreased mortality associated with different types of cancer, cardiovascular disease, and liver disease. Studies also find decreased maternal mortality, and one study found a decrease in infant mortality among Hispanics only.^{3 ,4 ,5 ,6 ,7 ,8 ,9 ,10} 
  • However, other studies suggest no effect of expansion on mortality among safety-net hospital patients, individuals with glottic cancer, individuals with glioblastoma, patients undergoing hemodialysis, and overall infant mortality. One study found no significant difference between COVID-19 mortality rates in expansion versus non-expansion states, despite lower incidence rates in expansion states. One study concluded that available data was insufficient to adequately identify the impact of expansion on opioid mortality.^{11 ,12 ,13 ,14 ,15 ,16 ,17 ,18 ,19} 

Cancer, Chronic Disease, and Disabilities

Recent research finds largely positive impacts of expansion on coverage and access to care among populations with cancer, chronic disease, and/or disabilities. However, findings on utilization of care and health outcomes are more mixed, with some studies suggesting improvements and others finding no effect of expansion. These studies build on prior research indicating generally positive effects of expansion for populations with cancer and other health conditions. Recent research also provides additional evidence on expansion’s impacts across a range of chronic conditions considered by the CDC to put people at higher risk of severe illness and death from COVID-19 (such as diabetes, obesity, and lung and heart conditions).

• Cancer. A large body of recent research considers the impact of Medicaid expansion on coverage, treatment, and outcomes of people with cancer, as well as access to cancer screenings.
  • Coverage of people with cancer. Studies overwhelmingly find that Medicaid expansion has increased insurance coverage rates among cancer patients and survivors. Research also finds changes in payer mix of care for patients with cancer, with declines in the proportion of uninsured patients and increases in the proportion of Medicaid-insured patients.^{20 ,21 ,22 ,23 ,24 ,25 ,26 ,27 ,28 ,29 ,30 ,31 ,32 ,33 ,34 ,35 ,36 ,37 ,38 ,39 ,40 ,41 ,42 ,43} 
  • Cancer diagnosis, treatment, and outcomes. Most studies find an association between expansion and increases in early-stage diagnosis rates among cancer patients, suggesting that expansion has facilitated earlier utilization of care for these patients. Findings on utilization of cancer treatment services and on access to timely treatment are mixed, though more studies find improvements as compared to studies that find no effect of expansion. Of studies that consider cancer mortality, three suggest improvements for patients with certain types of cancer, while three suggest no effect for patients with other types of cancer.^{44 ,45 ,46 ,47 ,48 ,49 ,50 ,51 ,52 ,53 ,54 ,55 ,56 ,57 ,58 ,59 ,60 ,61 ,62 ,63 ,64 ,65 ,66 ,67 ,68 ,69 ,70 ,71 ,72 ,73 ,74 ,75} 
  • Cancer screening and prevention. Several studies find that expansion increased receipt of cancer screenings such as mammograms, though a similar number of studies find no effect of expansion on screening rates for certain cancers. Two studies identified an association between expansion and increased rates of human papillomavirus (HPV) vaccines (overall and among teenagers specifically), while a third found no effect of expansion on HPV vaccination rates among female community health center patients.^{76 ,77 ,78 ,79 ,80 ,81 ,82 ,83 ,84} 
• Diabetes. Studies find that expansion increased insurance coverage rates among adults and teenagers with diabetes. Although research indicates that expansion increased affordability of health care for populations with diabetes, findings on utilization of preventive care and treatment are more mixed (between studies finding improvements and studies finding no effect). Two studies identified improvements in diabetes biomarkers among community health center patients following expansion. Two studies that considered women of reproductive age found that expansion did not affect the prevalence of diabetes prior to or during pregnancy.^{85 ,86 ,87 ,88 ,89 ,90 ,91 ,92 ,93 ,94 ,95 ,96} 
• Other chronic disease. In addition to cancer and diabetes, research also considers a range of other chronic conditions including cardiovascular and pulmonary diseases, obesity, and liver disease. Studies find that among those with chronic disease, expansion contributed to increased insurance coverage and improvements in payer mix, improved access to care, and better health outcomes including disease management and mortality. Findings on effects on treatment utilization and quality of care were mixed (between studies finding improvements and studies finding no effect). Finally, studies generally suggest that expansion increased screening for chronic conditions but did not reduce the prevalence of these conditions except for smoking.^{97 ,98 ,99 ,100 ,101 ,102 ,103 ,104 ,105 ,106 ,107 ,108 ,109 ,110 ,111 ,112 ,113 ,114 ,115 ,116 ,117 ,118 ,119 ,120 ,121 ,122 ,123} 
• People with disabilities. A small number of recent studies consider the impacts of expansion for people with disabilities. One study found increased coverage options for people with disabilities in expansion states, while other studies suggested no effect of expansion on utilization of care or employment among this population. One study found that expansion improved mental health outcomes for caregivers of people with disabilities.^{124 ,125 ,126 ,127 ,128} 

Sexual and Reproductive Health

Recent research finds that expansion has contributed to improvements in a number of outcomes related to sexual and reproductive health. This body of research includes findings related to women’s health and HIV/AIDS outcomes, both areas of health care that have faced increased challenges during the coronavirus pandemic. Building on prior research finding positive impacts among people of reproductive age, recent research indicates that expansion has improved measures including coverage rates before, during, and after pregnancy; maternal mortality and infant health outcomes; utilization of the most effective contraceptive methods; and screening for HIV/AIDS.

• Maternal and infant health outcomes. Studies find that expansion significantly increased access to and utilization of health care for pregnant women and mothers. Two studies found significant declines in maternal mortality, in contrast to one study which found no impact of expansion on certain health outcomes during pregnancy. Studies generally suggest an association between expansion and improvements in birth outcomes such as low birthweight, but find no impact on infant mortality (except for one study which found a reduction in Hispanic infant mortality only).^{129 ,130 ,131 ,132 ,133 ,134 ,135 ,136 ,137 ,138 ,139 ,140} 
• Postpartum insurance coverage. Although the American Rescue Plan Act of 2021 created a new option to expand postpartum coverage to 12 months via a State Plan Amendment, current federal statute requires that pregnancy-related Medicaid coverage continue through just 60 days. Research indicates that ACA Medicaid expansion has decreased coverage loss after this 60-day period ends: all recent studies that consider rates of insurance coverage after pregnancy find that expansion significantly increased postpartum coverage. Studies also suggest an association between expansion and increased coverage prior to and during pregnancy.^{141 ,142 ,143 ,144 ,145 ,146 ,147 ,148 ,149} 
• Access to contraception. Most studies find that expansion increased utilization of the most effective contraception methods (long-acting reversible contraception, which includes IUDs and implants); however, studies generally find no effect on overall contraception use. One study found an association between expansion and improved payer mix for contraceptive visits at safety net clinics, with a decline in the proportion of uninsured patients and an increase in the proportion of publicly-insured patients.^{150 ,151 ,152 ,153 ,154 ,155} 
• HIV/AIDS screening and outcomes. Studies suggest that expansion increased overall rates of HIV screening, including one study that found that increases in HIV test and diagnosis rates occurred despite no change in actual HIV incidence. Research also indicates higher insurance coverage rates among people with or at risk of HIV, increased utilization of Pre-Exposure Prophylaxis (PrEP) to treat HIV, and improved quality of care for patients with HIV.^{156 ,157 ,158 ,159 ,160 ,161 ,162 ,163 ,164 ,165 ,166 ,167} 

Behavioral Health

A growing body of research finds that expansion is associated with improvements in access to care and outcomes related to substance use disorder (SUD) as well as other mental health care. These findings are consistent with prior research indicating positive effects of expansion on behavioral health care access and outcomes. Recent research on SUD largely focuses on opioid use disorder (OUD) specifically, which is more prevalent among Medicaid enrollees as compared to the general population. Given the impacts of the coronavirus pandemic on mental health and substance use, Medicaid expansion coverage is likely to continue to serve as a significant source of coverage for behavioral health care.

• Access to care and outcomes for SUD. Studies find that Medicaid expansion was associated with increased insurance coverage among adults with SUD and improved payer mix of SUD-related visits (declines in uninsured patients and/or increases in Medicaid-covered patients). Studies also find that expansion increased the receipt of medication assisted treatment (MAT) prescriptions for the treatment of OUD, and that following expansion opioid treatment facilities were more likely to offer MAT and comprehensive mental health services. In contrast, a small number of studies found no effect of expansion on utilization of certain health care services for SUD. One study found no effect of expansion on drug-overdose deaths, while a second concluded that available data was insufficient to adequately identify the impact of expansion on drug-related mortality.^{168 ,169 ,170 ,171 ,172 ,173 ,174 ,175 ,176 ,177 ,178 ,179 ,180 ,181} 
• Mental health care access and outcomes. Studies find that expansion increased access to care for adults with mental health conditions such as depression, including by increasing the likelihood that mental health care providers accepted Medicaid. Findings on utilization of mental health care are more mixed, with some studies suggesting increased utilization of services such as mental health care via telehealth, and others finding no effect of expansion on other mental health services. Findings on mental health outcomes are also mixed: one study found that expansion was associated with improvements in self-reported mental health among low-income adults, while two other studies found no impact on similar measures among near-elderly adults and among women of reproductive age.^{182 ,183 ,184 ,185 ,186 ,187 ,188 ,189 ,190 ,191 ,192 ,193} 

Economic Impacts on States and Providers

Building on prior research, recent studies identify positive financial impacts of Medicaid expansion for states, hospitals, and other providers. These studies join a body of prior research finding overwhelmingly positive effects of expansion on economic outcomes (see Appendix A, Figure 5). These economic findings are particularly relevant given fiscal stress experienced by both states and Medicaid providers during the coronavirus pandemic.

• State budgets and economies. All recent studies that consider the financial impacts of expansion for states find positive effects. Studies find that expansion states experienced increased federal Medicaid spending. One study found that through 2018, Medicaid expansion led to increased federal spending in expansion states but very small (<1%), insignificant increases in spending from state sources (including in 2017 and 2018 when states began paying 5% and 6% of expansion costs respectively, a rate that was subsequently phased to 10% in 2020 and beyond). In addition, Medicaid expansion did not crowd out other areas of state spending and states that did not expand passed up $43 billion in federal funds in 2018. Research also finds that expansion resulted in increased revenue as well as net state savings by offsetting state costs in other areas, such as state spending on substance use disorder (SUD) treatment and on the traditional Medicaid program. One study found that the mortality reductions associated with expansion resulted in between $20.97 and $101.8 billion in annual welfare gains, implying that mortality-related savings alone may offset the entire net cost of expansion.^{194 ,195 ,196 ,197 ,198} 
• Payer mix. Studies overwhelmingly find that Medicaid expansion has resulted in payer mix improvements (declines in uninsured patients and/or increases in Medicaid-covered patients). Findings include payer mix improvements for hospitalizations, emergency department visits, and visits to community health centers and other safety-net clinics. Studies identify payer mix improvements among patients hospitalized for a range of specific conditions including traumatic injuries, surgeries, and treatment for substance use disorder. In line with payer mix improvements, studies also find decreased uncompensated care costs (UCC) overall and for specific types of hospitals, including those in rural areas.^{199 ,200 ,201 ,202 ,203 ,204 ,205 ,206 ,207 ,208 ,209 ,210 ,211 ,212 ,213 ,214 ,215 ,216 ,217 ,218 ,219 ,220 ,221 ,222 ,223 ,224 ,225 ,226 ,227 ,228 ,229 ,230} 
• Financial performance of hospitals and other providers. Research finds that expansion contributed to increased hospital revenue overall and from specific services. Although studies find that expansion has improved provider operating margins and profitability, these findings vary by hospital type. For example, one study found that despite declines in UCC and increases in Medicaid revenue across all hospital types, only hospitals in non-metropolitan areas and small hospitals experienced improved profit margins; another study similarly found gains in overall revenue only for rural and small hospitals. A few studies suggest that improvements in payer mix and UCC at hospitals may have been partially offset by increases in unreimbursed Medicaid care and declines in commercial revenue. One recent study found that expansion reduced the number of annual hospital closures.^{231 ,232 ,233 ,234 ,235 ,236 ,237 ,238 ,239 ,240 ,241} 

Disparities

A growing body of research considers the impact of Medicaid expansion on disparities in different outcomes by race/ethnicity, socioeconomic status, and other categories. These studies build on an earlier literature review finding that expansion has helped to narrow racial disparities in coverage and certain health outcomes, with more limited evidence suggesting reduced racial disparities in access to and use of care. Some studies on racial/ethnic disparities cited here are also included in this earlier review, which included studies published through July 2020.

• Disparities by race/ethnicity. Findings on expansion’s impact on racial disparities in health coverage, access, and outcomes are mixed and generally mirror findings from a previous literature review, with evidence of decreased racial disparities for some populations in measures including coverage rates, affordability of care, utilization of surgery and other services, and health outcomes including maternal and infant mortality. However, similar numbers of studies identify no effect of expansion on racial disparities in these and other measures. A very small number of studies find evidence of increased racial disparities (in coverage rates for specific populations and in breast cancer mortality). Across outcomes, most research focuses on disparities for Black and Hispanic individuals, with limited findings on impacts for other groups of color.^{242 ,243 ,244 ,245 ,246 ,247 ,248 ,249 ,250 ,251 ,252 ,253 ,254 ,255 ,256 ,257 ,258 ,259 ,260 ,261 ,262 ,263 ,264 ,265 ,266 ,267 ,268 ,269 ,270 ,271 ,272 ,273 ,274 ,275 ,276 ,277 ,278 ,279 ,280} 
• Disparities by socioeconomic status (income and/or education). In contrast to research on racial disparities, recent studies that consider socioeconomic disparities all find improvements. Studies find that expansion has reduced disparities in coverage by income and/or education status, including for populations with certain cancer diagnoses. A smaller number of studies also find decreased socioeconomic disparities in utilization of care, certain health outcomes such as maternal mortality, and individual financial stability.^{281 ,282 ,283 ,284 ,285 ,286 ,287 ,288 ,289 ,290 ,291} 
• Disparities by other categories. A few recent studies identify an association between expansion and reduced coverage disparities by age, sex, and marital status, but no effect on coverage disparities by work status and obesity. One study found that expansion reduced age disparities in individual financial stability. Another study found no effect of expansion on disparities by sex in receipt of HIV tests.^{292 ,293 ,294 ,295 ,296 ,297 ,298} 

Social Determinants of Health

Recent research indicates largely positive impacts of expansion associated with different social determinants of health. These recent studies are consistent with prior research on expansion’s effect on social determinants of health and also contribute new evidence on effects for certain measures. Social determinants of health are the conditions in which people are born, grow, live, work, and age. Improvements in these measures associated with expansion could help to mitigate increased hardship due to the coronavirus pandemic.

• Access to care in rural areas. Studies find that expansion was associated with greater improvements in access to care in rural areas, including increased HIV diagnosis rates and access to mental health care. In contrast, one study found that utilization of tobacco cessation treatment remained limited in rural Appalachia even after Medicaid expansion in Kentucky. Research also suggests that rural hospitals experienced particularly substantial improvements in financial performance following expansion.^{299 ,300 ,301 ,302 ,303 ,304 ,305 ,306 ,307} 
• Impacts on economic stability, employment, and educational outcomes. Studies find that expansion decreased catastrophic health expenditures (health care spending as a percentage of family income). One study found that expansion was associated with greater increases in income among low-income individuals and contributed to decreased levels of income inequality. One study found an association between expansion and decreased odds of job loss, though two other studies found no effect of expansion on employment among people with disabilities. Finally, a national study found significant reductions in high school dropout rates in the first year of expansion implementation, which would translate to an 11.2% reduction in drop-out rates in non-expansion states if they adopted the expansion.^{308 ,309 ,310 ,311 ,312 ,313 ,314} 
• Outcomes for justice-involved and individuals experiencing homelessness. One study found that although pregnant women referred by criminal justice agencies to opioid use disorder (OUD) treatment facilities received medication as treatment at lower rates than women referred by other sources, expansion mitigated this effect by increasing receipt of medication for these women. Another study found that expansion resulted in decreased rates of recidivism in some geographic areas. A study in Arkansas found a spike in utilization of acute care among adults experiencing homelessness who gained coverage through expansion, suggesting a pent-up demand that stabilized in the years following expansion implementation.^{315 ,316 ,317}  

Looking Ahead

This literature review builds on a prior report and summarizes new evidence on more specific outcomes for certain populations. The full body of Medicaid expansion research includes over 600 studies (summarized in Appendix A) and indicates overall positive effects across a range of outcomes for patients, providers, and states. These findings suggest that Medicaid expansion could help mitigate adverse impacts of the coronavirus pandemic at the patient, provider, and state level; although research to date on Medicaid expansion and COVID-19 remains limited, future studies will likely further consider these impacts. Additionally, continued research cited in this report demonstrating positive economic impacts may help inform states still debating whether to adopt the expansion, particularly given the new ARPA financial incentive that would more than offset state expansion costs for two years (after which states would continue to bear 10% of the cost). Future policy proposals at the state and federal level could further affect Medicaid expansion coverage and options for people in the coverage gap.

Appendix A: Summary Figures, January 2014 – March 2021

The recent studies included in this literature review build on existing research indicating that expansion is linked to gains in coverage; improvements in access, financial security, some measures of health status/outcomes; and economic benefits for states and providers (Appendix Figure 1). This appendix contains updated figures summarizing research on the effects of expansion originally published in an earlier literature review. These figures reflect all 601 included studies on the effects of ACA Medicaid expansion published between January 2014 and March 2021.

Study focus over time (Appendix Figure 2). While most early studies focused on expansion’s impact on coverage and economic measures, over time studies have increasingly focused on measures related to access to care.

Coverage (Appendix Figure 3). The full body of research finds positive effects of Medicaid expansion on a range of outcomes related to insurance coverage, including Medicaid coverage gains and reductions in uninsured rates overall and for specific populations. Research suggests limited effects on private coverage rates. Studies also find that expansion has narrowed racial disparities in health coverage for some populations.

Access (Appendix Figure 4). The full body of research finds positive effects of Medicaid expansion on a range of outcomes related to access. In addition to increased access to and utilization of care, studies find that expansion has improved metrics related to quality of care, self-reported health, and health outcomes; provider capacity; and affordability and financial security.

Economic effects (Appendix Figure 5). Studies find positive effects of Medicaid expansion on a range of economic measures. Economic effects of expansion include improvements in payer mix and other impacts on hospitals and other providers and positive effects on state budgets and economies. Studies also consider Medicaid spending per enrollee, marketplace effects, and employment and labor market effects.

Appendix B: Study Citations by Category of Findings and Geographic Scope, January 2014 – March 2021

DOWNLOAD APPENDIX B (.pdf)Note: This file is best viewed when downloaded and opened in Adobe Acrobat.

Bibliography, January 2014 – March 2021

DOWNLOAD BIBLIOGRAPHY (.pdf)Note: This file is best viewed when downloaded and opened in Adobe Acrobat.

1. Mark Borgschulte and Jacob VoglerbaI, “Did the ACA Medicaid Expansion Save Lives?,” Journal of Health Economics 72 (July 2020), https://doi.org/10.1016/j.jhealeco.2020.102333 ↩︎
2. Brandon W. Yan, Frank A. Sloan, W. John Boscardin, Felicia Guo, and R. Adams Dudley, “The Opioid Epidemic Blunted the Mortality Benefit of Medicaid Expansion,” Medical Care Research and Review Epub ahead of print (May 2020), https://journals.sagepub.com/doi/10.1177/1077558720919620 ↩︎
3. Ying Liu, Graham A. Colditz, Benjamin D. Kozower, “Association of Medicaid Expansion Under the Patient Protection and Affordable Care Act With Non-Small Cell Lung Cancer Survival,” JAMA Oncology 6 no. 8 (August 2020): 1145-1308, https://jamanetwork.com/journals/jamaoncology/issue/6/8 ↩︎
4. David Barrington et. al., “Where You Live Matters: A National Cancer Database Study of Medicaid Expansion and Endometrial Cancer Outcomes,” Gynecologic Oncology 158 no. 2 (August 2020): 407-414, https://doi.org/10.1016/j.ygyno.2020.05.018 ↩︎
5. Miranda B. Lam, Jessica Phelan, John Orav, Ashish K. Jha, and Nancy L. Keating, “Medicaid Expansion and Mortality Among Patients With Breast, Lung, and Colorectal Cancer,” Jama Network Open 3 no. 11 (November 2020), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772535 ↩︎
6. Justin T. Moyers, Amie Patel, Wendy Shih, and Gayathri Nagaraj, “Association of Sociodemographic Factors With Immunotherapy Receipt for Metastatic Melanoma in the US,” JAMA Network Open 3 no. 9 (September 2020), https://doi.org/10.1001/jamanetworkopen.2020.15656 ↩︎
7. Sadiya S. Khan, Donald M. Lloyd Jones, Mercedes Carnethon, Lindsay R. Pool, “Medicaid Expansion and State-Level Differences in Premature Cardiovascular Mortality by Subtype, 2010–2017,” Hypertension 76 (September 2020): 37-38, https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.15968 ↩︎
8. Smriti Rajita Kumar, Sameed Ahmed M. Khatana, and David Goldberg, “Impact of Medicaid Expansion on Liver-Related Mortality,” Clinical Gastroenterology and Hepatology Epub ahead of print (December 2020), https://www.cghjournal.org/article/S1542-3565(20)31632-3/fulltext ↩︎
9. Erica Eliason, “Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality,” Women’s Health Issues 30, no. 3 (May-June 2020): 147-152, https://doi.org/10.1016/j.whi.2020.01.005 ↩︎
10. Alexandra Wiggins, Ibraheem M. Karaye, Jennifer A. Horney, “Medicaid Expansion and Infant Mortality, Revisited: A Difference-In-Differences Analysis,” Health Services Research 55, no. 3 (March 2020): 393-398, https://doi.org/10.1111/1475-6773.13286 ↩︎
11. Paula Chatterjee, Mingyu Qi, Rachel M Werner, “Association of Medicaid Expansion With Quality in Safety-Net Hospitals,” Jama Internal Medicine Epub ahead of print (February 2021), https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2775956 ↩︎
12. Bharat Akhanda Panuganti, Emelia Stuart, Philip Weissbrod, “Changes In Treatment Trends in the Early Glottic Cancer Population after the Affordable Care Act,” Journal of the Sciences and Specialties of the Head and Neck 43 no. 1 (September 2020): 137-144, https://onlinelibrary.wiley.com/doi/10.1002/hed.26463 ↩︎
13. Nuriel Moghavem et al., “Impact of the Patient Protection and Affordable Care Act on 1-year Survival in Glioblastoma Patients,” Neuro-Oncology Advances 2 no. 1 (January-December 2020): 1-10, https://doi.org/10.1093/noajnl/vdaa080 ↩︎
14. Scott R. Levin et al., “Association of Medicaid Expansion with Tunneled Dialysis Catheter Use at the Time of First Arteriovenous Access Creation,” Annals of Vascular Surgery Epub ahead of print (January 2021), https://www.annalsofvascularsurgery.com/article/S0890-5096(21)00082-0/fulltext ↩︎
15. Amanda Cooke and Amanda Stype, “Medicaid Expansion and Infant Mortality: The (Questionable) Impact of the Affordable Care Act,” Journal of Epidemiology and Community Health 75 no. 1 (January 2021): 10-15, https://jech.bmj.com/content/75/1/10 ↩︎
16. S. Marie Harvey, Lisa P. Oakley, Susannah E. Gibbs, Shyama Mahakalanda, Jeff Luck, and Jangho Yoon, “Impact of Medicaid Expansion in Oregon on Access to Prenatal Care,” Preventative Medicine 143 (February 2021), https://www.sciencedirect.com/science/article/pii/S0091743520303911?via%3Dihub ↩︎
17. Jean Guglielminotti, Ruth Landau, and Guohua Li, “The 2014 New York States Medicaid Expansion and Severe Maternal Morbidity,” Anesthesia and Analgesia 10 (January 2021), https://journals.lww.com/anesthesia-analgesia/Abstract/9900/The_2014_New_York_State_Medicaid_Expansion_and.64.aspx ↩︎
18. Tim F. Liao and Fernando De Maio, “Association of Social and Economic Inequality With Coronavirus Disease 2019 Incidence and Mortality Across US Counties,” JAMA Network Open 4, no.1 (January 2021), https://doi.org/10.1001/jamanetworkopen.2020.34578 ↩︎
19. Rahi Abouk, Lorens Helmchen, Ali Moghtaderi, and Jesse Pines, “The ACA Medicaid Expansions and Opioid Mortality: Is There a Link?,” Medical Care Research and Review Epub ahead of print (October 2020), https://doi.org/10.1177/1077558720967227 ↩︎
20. Ying Liu et al., “Association of Medicaid Expansion Under the Patient Protection and Affordable Care Act With Non-Small Cell Lung Cancer Survival,” JAMA Oncology 6 no. 8 (August 2020): 1289-1290, https://doi.org/doi:10.1001/jamaoncol.2020.1040 ↩︎
21. Wen Liu, Michael Goodman, and Christopher P. Filson, “Association of State-Level Medicaid Expansion With Treatment of Patients With Higher-Risk Prostate Cancer,” Jama Open Network 3 no. 10 (October 2020), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2771396 ↩︎
22. Archana Babu et al., “The Affordable Care Act: Implications for Underserved Populations with Head & Neck Cancer,” American Journal of Otolaryngology 41, no. 4 (July-August 2020), https://doi.org/10.1016/j.amjoto.2020.102464 ↩︎
23. Nosayaba Osazuwa-Peters et al., “State Medicaid Expansion Status, Insurance Coverage and Stage at Diagnosis in Head and Neck Cancer Patients,” Oral Oncology 110 (November 2020), https://doi.org/10.1016/j.oraloncology.2020.104870 ↩︎
24. David Barrington et. al., “Where You Live Matters: A National Cancer Database Study of Medicaid Expansion and Endometrial Cancer Outcomes,” Gynecologic Oncology 158 no. 2 (August 2020): 407-414, https://doi.org/10.1016/j.ygyno.2020.05.018 ↩︎
25. Azeem Tariq Malik, John Alexander, Safdar Khan, and Thomas J. Scharschmidt, “Has the Affordable Care Act Been Associated with Increased Insurance Coverage and Early-stage Diagnoses of Bone and Soft-tissue Sarcomas in Adults?,” Clinical Orthapaedics and Related Research Epub ahead of print (March 2021), https://doi.org/10.1097/CORR.0000000000001438 ↩︎
26. Ari D. Schuman et al., “Changes in Diagnosis of Thyroid Cancer Among Medicaid Beneficiaries Following Medicaid Expansion,” JAMASurgery 155 no. 11 (September 2020): 1080-1081, https://doi.org/doi:10.1001/jamasurg.2020.3290 ↩︎
27. Bharat Akhanda Panuganti, Emelia Stuart, and Philip Weissbrod, “Changes In Treatment Trends in the Early Glottic Cancer Population after the Affordable Care Act,” Journal of the Sciences and Specialties of the Head and Neck 43 no. 1 (September 2020): 137-144, https://doi.org/10.1002/hed.26463 ↩︎
28. Heather Angier et al., “The Affordable Care Act Improved Health Insurance Coverage and Cardiovascular-Related Screening Rates for Cancer Survivors Seen in Community Health Centers,” Cancer 126 no. 14 (July 2020): 3303-3311, https://doi.org/10.1002/cncr.32900 ↩︎
29. Nuriel Moghavem et al., “Impact of the Patient Protection and Affordable Care Act on 1-year Survival in Glioblastoma Patients,” Neuro-Oncology Advances 2 no. 1 (January-December 2020): 1-10, https://doi.org/10.1093/noajnl/vdaa080 ↩︎
30. Richard J. Straker et al., “Association of the Affordable Care Act’s Medicaid Expansion with the Diagnosis and Treatment of Clinically Localized Melanoma: A National Cancer Database Study” Journal of the Amerian Academy of Dermatology Epub ahead of print, (February 2021), https://www.jaad.org/article/S0190-9622(21)00308-X/pdf ↩︎
31. Samuel U. Takvorian et al., “Association of Medicaid Expansion Under the Affordable Care Act With Insurance Status, Cancer Stage, and Timely Treatment Among Patients With Breast, Colon, and Lung Cancer,” Jama Network Open 3 no. 2 (February 2020), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2761262 ↩︎
32. Adam B. Weiner et al., “Insurance Coverage, Stage at Diagnosis, and Time to Treatment Following Dependent Coverage and Medicaid Expansion for Men With Testicular Cancer,” PLOS ONE 15 no. 9 (September 2020), https://doi.org/10.1371/journal.pone.0238813 ↩︎
33. Benjamin B. Albright et al., “Impact of Medicaid Expansion on Women with Gynecologic Cancer: a Difference-in-Difference Analysis,” American Journal of Obstetrics and Gynecology 224 no. 2 (February 2021): 1-17, https://doi.org/10.1016/j.ajog.2020.08.007 ↩︎
34. Quyen D. Chu et al., “Positive Impact of the Patient Protection and Affordable Care Act Medicaid Expansion on Louisiana Women with Breast Cancer,” Cancer Epub ahead of print (November 2020), https://doi.org/10.1002/cncr.33265 ↩︎
35. Jessica Limberg et al., “Association of Medicaid Expansion of the Affordable Care Act with the Stage at Diagnosis and Treatment of Papillary Thyroid Cancer: A Difference-in-Differences Analysis,” The American Journal of Surgery Epub ahead of print (January 2021), https://www.americanjournalofsurgery.com/article/S0002-9610(21)00034-9/fulltext#articleInformation ↩︎
36. Richard S. Hoehn et al., “Association Between Medicaid Expansion and Diagnosis and Management of Colon Cancer,” Journal of the American College of Surgeons 232 no. 2 (February 2021), https://www.journalacs.org/article/S1072-7515(20)32462-5/fulltext ↩︎
37. Justin Le Blanc, Danielle Heller, Ann Friedrich, Donald Lannin, and Tristen Park, “Association of Medicaid Expansion Under the Affordable Care Act With Breast Cancer Stage at Diagnosis,” JAMA Surgery (July 2020), https://doi.org/10.1001/jamasurg.2020.1495 ↩︎
38. Adrian Diaz, Daniel Chavarin, Anghela Z. Paredes, and Timothy M. Pawlik, “Utilization of High-Volume Hospitals for High-Risk Cancer Surgery in California Following Medicaid Expansion,” Journal of Gastrointestinal Surgery Epub ahead of print (July 2020), https://link.springer.com/article/10.1007/s11605-020-04747-8 ↩︎
39. Johanna Catherine Maclean, Michael T. Halpern, Steven C. Hill, and Michael F. Pesko, “The Effect of Medicaid Expansion on Prescriptions for Breast Cancer Hormonal Therapy Medications,” Health Services Research, 55 no. 3 (April 2020): 399-410, https://doi.org/10.1111/1475-6773.13289 ↩︎
40. Jason Tong et al., “The Impact of the Affordable Care Act on Surgeon Selection Amongst Colorectal Surgery Patients,” The American Journal of Surgery Epub ahead of print (February 2021), https://doi.org/10.1016/j.amjsurg.2021.01.041 ↩︎
41. Uriel Kim, Siran Koroukian, Abby Statler, and Johnie Rose, “The Effect of Medicaid Expansion Among Adults from Low-Income Communities on Stage at Diagnosis in Those with Screening-Amenable Cancers,” Cancer 126, no. 18 (September 2020): 4209-4219, https://doi-org.proxy.library.cornell.edu/10.1002/cncr.32895 ↩︎
42. Dan Kirkpatrick, Margaret Dunn, and Rebecca Tuttle, “Breast Cancer Stage at Presentation in Ohio: The Effect of Medicaid Expansion and the Affordable Care Act,” The American surgeon 86, no. 3 (2020): 195–199, https://pubmed.ncbi.nlm.nih.gov/32223797/ ↩︎
43. Anuj S. Desai et al., “Medicaid Expansion Did not Improve Time to Treatment for Young Patients With Metastatic Renal Cell Carcinoma,” Clinical Genitourinary Prostate, Kidney, & Bladder Cancer 18 no. 4 (August 2020):386-390, https://doi.org/10.1016/j.clgc.2020.01.006 ↩︎
44. Ying Liu et al., “Association of Medicaid Expansion Under the Patient Protection and Affordable Care Act With Non-Small Cell Lung Cancer Survival,” JAMA Oncology 6 no. 8 (August 2020): 1289-1290, https://doi.org/doi:10.1001/jamaoncol.2020.1040 ↩︎
45. Justin Le Blanc, Danielle Heller, Ann Friedrich, Donald Lannin, and Tristen Park, “Association of Medicaid Expansion Under the Affordable Care Act With Breast Cancer Stage at Diagnosis,” JAMA Surgery (July 2020), https://doi.org/10.1001/jamasurg.2020.1495 ↩︎
46. Azeem Tariq Malik, John Alexander, Safdar Khan, and Thomas J. Scharschmidt, “Has the Affordable Care Act Been Associated with Increased Insurance Coverage and Early-stage Diagnoses of Bone and Soft-tissue Sarcomas in Adults?,” Clinical Orthapaedics and Related Research Epub ahead of print (March 2021), https://doi.org/10.1097/CORR.0000000000001438 ↩︎
47. Bharat Akhanda Panuganti, Emelia Stuart, and Philip Weissbrod, “Changes In Treatment Trends in the Early Glottic Cancer Population after the Affordable Care Act,” Journal of the Sciences and Specialties of the Head and Neck 43 no. 1 (September 2020): 137-144, https://doi.org/10.1002/hed.26463 ↩︎
48. Richard J. Straker et al., “Association of the Affordable Care Act’s Medicaid Expansion with the Diagnosis and Treatment of Clinically Localized Melanoma: A National Cancer Database Study” Journal of the Amerian Academy of Dermatology Epub ahead of print, (February 2021), https://www.jaad.org/article/S0190-9622(21)00308-X/pdf ↩︎
49. Nosayaba Osazuwa-Peters et al., “State Medicaid Expansion Status, Insurance Coverage and Stage at Diagnosis in Head and Neck Cancer Patients,” Oral Oncology 110 (November 2020), https://doi.org/10.1016/j.oraloncology.2020.104870 ↩︎
50. Neelima Panth et al., “Change in Stage of Presentation of Head and Neck Cancer in the United States Before and After the Affordable Care Act,” Cancer Epidemiology 67 (August 2020), https://doi.org/10.1016/j.canep.2020.101763 ↩︎
51. Ari D. Schuman et al., “Changes in Diagnosis of Thyroid Cancer Among Medicaid Beneficiaries Following Medicaid Expansion,” JAMASurgery 155 no. 11 (September 2020): 1080-1081, https://doi.org/doi:10.1001/jamasurg.2020.3290 ↩︎
52. Samuel U. Takvorian et al., “Association of Medicaid Expansion Under the Affordable Care Act With Insurance Status, Cancer Stage, and Timely Treatment Among Patients With Breast, Colon, and Lung Cancer,” Jama Network Open 3 no. 2 (February 2020), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2761262 ↩︎
53. Michelle C. Salazar et al., “Evaluation of Cancer Care After Medicaid Expansion Under the Affordable Care Act,” JAMA Network Open 3 no. 9 (September 2020), https://doi.org/10.1001/jamanetworkopen.2020.17544 ↩︎
54. Adam B. Weiner et al., “Changes in Prostate-Specific Antigen at the Time of Prostate Cancer Diagnosis After Medicaid Expansion in Young Men,” Cancer 126 no. 14 (July 2020): 3229-3236, https://doi.org/10.1002/cncr.32930 ↩︎
55. Quyen D. Chu et al., “Positive Impact of the Patient Protection and Affordable Care Act Medicaid Expansion on Louisiana Women with Breast Cancer,” Cancer Epub ahead of print (November 2020), https://doi.org/10.1002/cncr.33265 ↩︎
56. Richard S. Hoehn et al., “Association Between Medicaid Expansion and Diagnosis and Management of Colon Cancer,” Journal of the American College of Surgeons 232 no. 2 (February 2021), https://www.journalacs.org/article/S1072-7515(20)32462-5/fulltext ↩︎
57. Uriel Kim, Siran Koroukian, Abby Statler, and Johnie Rose, “The Effect of Medicaid Expansion Among Adults from Low-Income Communities on Stage at Diagnosis in Those with Screening-Amenable Cancers,” Cancer 126, no. 18 (September 2020): 4209-4219, https://doi-org.proxy.library.cornell.edu/10.1002/cncr.32895 ↩︎
58. David Barrington et. al., “Where You Live Matters: A National Cancer Database Study of Medicaid Expansion and Endometrial Cancer Outcomes,” Gynecologic Oncology 158 no. 2 (August 2020): 407-414, https://doi.org/10.1016/j.ygyno.2020.05.018 ↩︎
59. Adam B. Weiner et al., “Insurance Coverage, Stage at Diagnosis, and Time to Treatment Following Dependent Coverage and Medicaid Expansion for Men With Testicular Cancer,” PLOS ONE 15 no. 9 (September 2020), https://doi.org/10.1371/journal.pone.0238813 ↩︎
60. Benjamin B. Albright et al., “Impact of Medicaid Expansion on Women with Gynecologic Cancer: a Difference-in-Difference Analysis,” American Journal of Obstetrics and Gynecology 224 no. 2 (February 2021): 1-17, https://doi.org/10.1016/j.ajog.2020.08.007 ↩︎
61. Jessica Limberg et al., “Association of Medicaid Expansion of the Affordable Care Act with the Stage at Diagnosis and Treatment of Papillary Thyroid Cancer: A Difference-in-Differences Analysis,” The American Journal of Surgery Epub ahead of print (January 2021), https://www.americanjournalofsurgery.com/article/S0002-9610(21)00034-9/fulltext#articleInformation ↩︎
62. Lauren Lin, Aparna Soni, Lindsay M. Sabik, and Coleman Drake, “Early- and Late-Stage Cancer Diagnosis Under 3 Years of Medicaid Expansion,” American Journal of Preventative Medicine 60 no. 1 (January 2021):104-109, https://doi.org/10.1016/j.amepre.2020.06.020 ↩︎
63. Dan Kirkpatrick, Margaret Dunn, and Rebecca Tuttle, “Breast Cancer Stage at Presentation in Ohio: The Effect of Medicaid Expansion and the Affordable Care Act,” The American surgeon 86, no. 3 (2020): 195–199, https://pubmed.ncbi.nlm.nih.gov/32223797/ ↩︎
64. Adrian Diaz, Daniel Chavarin, Anghela Z. Paredes, and Timothy M. Pawlik, “Utilization of High-Volume Hospitals for High-Risk Cancer Surgery in California Following Medicaid Expansion,” Journal of Gastrointestinal Surgery Epub ahead of print (July 2020), https://link.springer.com/article/10.1007/s11605-020-04747-8 ↩︎
65. Adam B. Weiner et al., “Insurance Coverage, Stage at Diagnosis, and Time to Treatment Following Dependent Coverage and Medicaid Expansion for Men With Testicular Cancer,” PLOS ONE 15 no. 9 (September 2020), https://doi.org/10.1371/journal.pone.0238813 ↩︎
66. Neal Bhutiani et al., “Identifying Factors Influencing Delays in Breast Cancer Treatment in Kentucky Following the 2014 Medicaid Expansion,” Journal of Surgical Oncology 121 no. 8 (June 2020): 1191-1200, https://doi.org/10.1002/jso.25914 ↩︎
67. Johanna Catherine Maclean, Michael T. Halpern, Steven C. Hill, and Michael F. Pesko, “The Effect of Medicaid Expansion on Prescriptions for Breast Cancer Hormonal Therapy Medications,” Health Services Research, 55 no. 3 (April 2020): 399-410, https://doi.org/10.1111/1475-6773.13289 ↩︎
68. Nuriel Moghavem et al., “Impact of the Patient Protection and Affordable Care Act on 1-year Survival in Glioblastoma Patients,” Neuro-Oncology Advances 2 no. 1 (January-December 2020): 1-10, https://doi.org/10.1093/noajnl/vdaa080 ↩︎
69. Justin T. Moyers, Amie Patel, Wendy Shih, and Gayathri Nagaraj, “Association of Sociodemographic Factors With Immunotherapy Receipt for Metastatic Melanoma in the US,” JAMA Network Open 3 no. 9 (September 2020), https://doi.org/10.1001/jamanetworkopen.2020.15656 ↩︎
70. Anuj S. Desai et al., “Medicaid Expansion Did not Improve Time to Treatment for Young Patients With Metastatic Renal Cell Carcinoma,” Clinical Genitourinary Prostate, Kidney, & Bladder Cancer 18 no. 4 (August 2020):386-390, https://doi.org/10.1016/j.clgc.2020.01.006 ↩︎
71. Wen Liu, Michael Goodman, and Christopher P. Filson, “Association of State-Level Medicaid Expansion With Treatment of Patients With Higher-Risk Prostate Cancer,” Jama Open Network 3 no. 10 (October 2020), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2771396 ↩︎
72. Heather Angier et al., “The Affordable Care Act Improved Health Insurance Coverage and Cardiovascular-Related Screening Rates for Cancer Survivors Seen in Community Health Centers,” Cancer 126 no. 14 (July 2020): 3303-3311, https://doi.org/10.1002/cncr.32900 ↩︎
73. Jason Tong et al., “The Impact of the Affordable Care Act on Surgeon Selection Amongst Colorectal Surgery Patients,” The American Journal of Surgery Epub ahead of print (February 2021), https://doi.org/10.1016/j.amjsurg.2021.01.041 ↩︎
74. Juan Chipollini and Grant R. Pollock, “National Trends in the Management of Low-Risk Prostate Cancer: Analyzing the Impact of Medicaid Expansion in the United States,” International Urology and Nephrology 52 no. 9 (September 2020): 1611–1615, https://doi.org/10.1007/s11255-020-02463-5 ↩︎
75. Miranda B. Lam, Jessica Phelan, John Orav, Ashish K. Jha, and Nancy L. Keating, “Medicaid Expansion and Mortality Among Patients With Breast, Lung, and Colorectal Cancer,” Jama Network Open 3 no. 11 (November 2020), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772535 ↩︎
76. Yoshiko Toyoda, Eun Jeong Oh, Ishani D. Premaratne, Codruta Chiuzan, and Christine H. Rohde, “Affordable Care Act State-Specific Medicaid Expansion: Impact on Health Insurance Coverage and Breast Cancer Screening Rate,” Journal of the American College of Surgeons 230 no. 5 (May 2020): 775-783, https://doi.org/10.1016/j.jamcollsurg.2020.01.031 ↩︎
77. Daniel B. Nelson et al., “Changes in Coverage, Access, and Health Following Implementation of Healthy Behavior Incentive Medicaid Expansions vs. Traditional Medicaid Expansions,” Journal of General Internal Medicine 35 (September 2020): 2521–2528, https://doi.org/10.1007/s11606-020-05801-6 ↩︎
78. Kirsten Y. Eoma, Marian Jarlenskia, Robert E. Schoenb, Linda Robertsonc, and Lindsay M. Sabika, “Sex Differences in the Impact of Affordable Care Act Medicaid Expansion on Colorectal Cancer Screening,” Preventive Medicine 138 (September 2020), https://doi.org/10.1016/j.ypmed.2020.106171 ↩︎
79. William C. Daly et al., “National Recommendations against Prostate Specific Antigen Screening versus Statewide Medicaid Expansion Initiatives: A Battle of the Titans,” The Journal of Urology Epub ahead of print (February 2021), https://doi.org/10.1097/JU.0000000000001594 ↩︎
80. Sri Lekha Tummalapalli and Salomeh Keylani, “Changes in Preventative Health Care After Medicaid Expansion,” Medical Care 58 no. 6 (June 2020): 549-556, https://doi.org/doi:10.1001/jamanetworkopen.2020.18728 ↩︎
81. Aparna Soni, “The Effects of Public Health Insurance on Health Behaviors: Evidence From the Fifth Year of Medicaid Expansion,” Health Economics 29 no. 12 (December 2020): 1586-1605, https://doi.org/10.1002/hec.4155 ↩︎
82. Brigit Hatch et al., “Impacts of the Affordable Care Act on Receipt of Women’s Preventive Services in Community Health Centers in Medicaid Expansion and Nonexpansion States,” Women’s Health Issues 31 no. 1 (January 2021): 9-16, https://www.whijournal.com/article/S1049-3867(20)30097-9/fulltext ↩︎
83. Brandon M. Hoff, Melvin D. Livingston III, and Erika L. Thompson, “The Association Between State Medicaid Expansion and Human Papillomavirus Vaccination,” Vaccine 38 no. 38 (August 2020): 5963-5965, https://www.sciencedirect.com/science/article/pii/S0264410X20309373?via%3Dihub ↩︎
84. Summer Sherburne Hawkins, Krisztina Horvath, Jessica Cohen, Lydia E. Pace, and Christopher F. Baum, “Associations Between Insurance-related Affordable Care Act Policy Changes with HPV Vaccine Completion,” BMC Public Health 21, no. 304 (Februrary 2021), https://doi.org/10.1186/s12889-021-10328-4 ↩︎
85. Alisha Monnette, Charles Stoecker, Elizabeth Nauman, and Lizheng Shi, “The Impact of Medicaid Expansion on Access to Care and Preventative Care for Adults with Diabetes and Depression,” Journal of Diabetes and its Complications 34 no. 10 (October 2020), https://doi.org/10.1016/j.jdiacomp.2020.107663 ↩︎
86. Dahai Yu, Yuhui Zu, Petra W. Rasmussen, James Godwin, and Ninez A. Ponce, “Coverage, Affordability, and Care for Low-Income People with Diabetes: 4 Years after the Affordable Care Act’s Medicaid Expansions,” Journal of Internal Medicine 35 (January 2020): 2222-2224, https://link.springer.com/article/10.1007/s11606-019-05614-2 ↩︎
87. Lily D. Yan, Mohammed K. Ali, and Kiersten L. Strombotne,”Impact of Expanded Medicaid Eligibility on the Diabetes Continuum of Care Among Low-Income Adults: A Difference-in-Differences Analysis,” American Journal of Preventative Medicine 60 no. 2 (February 2021): 189-192, https://doi.org/10.1016/j.amepre.2020.08.013 ↩︎
88. Barbara H. Braffett, “Health Care Coverage and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes: Results From the TODAY2 Study,” Diabetes Care 43, no. 10 (October 2020): 2469-2477, https://doi.org/10.2337/dc20-0760 ↩︎
89. Miguel Marino et al., “The Affordable Care Act: Effects of Insurance on Diabetes Biomarkers,” Diabetes Care, 43 no. 9 (September 2020): 2074-2081, https://doi.org/10.2337/dc19-1571 ↩︎
90. Miguel Marino et al., “Disparities in Biomarkers for Patients With Diabetes After the Affordable Care Act,” Medical Care 58 (June 2020), https://doi.org/10.1097/mlr.0000000000001257 ↩︎
91. Andrew Sumarsono et al., “Medicaid Expansion and Utilization of Antihyperglycemic Therapies,” Diabetes Care 43 no. 11, (November 2020): 2684-2690, https://care.diabetesjournals.org/content/43/11/2684 ↩︎
92. Heather Angier et al., “New Hypertension and Diabetes Diagnoses Following the Affordable Care Act Medicaid Expansion,” Family Medicine and Community Health 8 no. 4 (December 2020), https://fmch.bmj.com/content/8/4/e000607 ↩︎
93. Kenrik O. Duru et al., “Evaluation of a National Care Coordination Program to Reduce Utilization Among High-cost, High-need Medicaid Beneficiaries With Diabetes,” Medical Care 58 (June 2020): 14-21, https://journals.lww.com/lww-medicalcare/Fulltext/2020/06001/Evaluation_of_a_National_Care_Coordination_Program.5.aspx ↩︎
94. Sri Lekha Tummalapalli and Salomeh Keylani, “Changes in Preventative Health Care After Medicaid Expansion,” Medical Care 58 no. 6 (June 2020): 549-556, https://doi.org/doi:10.1001/jamanetworkopen.2020.18728 ↩︎
95. Claire E. Margerison, Robert Kaestner, Jiajia Chen, and Collen MacCallum-Bridges, “Impacts of Medicaid Expansion Prior to Conception on Pre-pregnancy Health, Pregnancy Health, and Outcomes,” American Journal of Epidemiology Epub ahead of print (January 2021), https://doi.org/10.1093/aje/kwaa289 ↩︎
96. Rebecca Myerson, Samuel Crawford, and Laura R. Wherry, “Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, And Postpartum Contraception,” Health Affairs 39 no. 11 (November 2020): 1883-1890, https://doi.org/10.1377/hlthaff.2020.00106 ↩︎
97. Rebecca Myerson and Samuel Crawford, “Coverage for Adults With Chronic Disease Under the First 5 Years of the Affordable Care Act,” Medical Care 58 no. 10 (October 2020): 861-866, https://doi.org/10.1097/MLR.0000000000001370 ↩︎
98. Chinedum O. Ojinnaka, and Yash Suri, “Impact of Medicaid Expansion on Healthcare Access Among Individuals Living With Chronic Diseases,” American Journal of Preventative Medicine 59 no. 2 (August 2020): 149-156, https://doi.org/10.1016/j.amepre.2020.03.012 ↩︎
99. Janani Rajbhandari-Thappa, Donglang Zhang, Kara E. MacLeod, Kiran Thapa, “Impact of Medicaid Expansion on Insurance Coverage Rates Among Adult Populations with Low Income and by Obesity Status” The Obesity Society 28 no. 7 (April 2020): 1219-1223, https://doi.org/10.1002/oby.22793 ↩︎
100. Mariam Kayle et al., “Impact of Medicaid Expansion on Access and Healthcare Among Individuals with Sickle Cell Disease,” Pediatric Blood and Cancer 67 no. 5 (May 2020), https://onlinelibrary.wiley.com/doi/abs/10.1002/pbc.28152 ↩︎
101. Erica M. Valdovinos, Matthew J. Niedzwiecki, Joanna Guo, and Renee Y. Hsia, “Effects of Medicaid Expansion on Access, Treatment and Outcomes for Patients with Acute Myocardial Infarction,” PLOS ONE 15 no. 4 (April 2020), https://doi.org/10.1371/journal.pone.0232097 ↩︎
102. Erica M. Valdovinos, Matthew J. Niedzwiecki, Joanna Guo, and Renee Y. Hsia, “The Association of Medicaid Expansion and Racial/Ethnic Inequities in Access, Treatment, and Outcomes for Patients with Acute Myocardial Infarction,” PLOS ONE 15 no. 11 (November 2020), https://doi.org/10.1371/journal.pone.0241785 ↩︎
103. Laurent C. Glance, Caroline P. Thirukumaran, Ernie Shippey, Stewart J. Lustik, and Andrew W. Dick, “Impact of Medicaid Expansion on Disparities in Revascularization in Patients Hospitalized with Acute Myocardial Infarction,” PLOS One Epub ahead of print (December 2020), https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243385 ↩︎
104. Monique Barakat et al., “Recent Trends and the Impact of the Affordable Care Act on Emergency Department Visits and Hospitalizations for Gastrointestinal, Pancreatic, and Liver Diseases,” Journal of Clinical Gastroenterology 54 no. 3 (March 2020), https://doi.org/10.1097/MCG.0000000000001102 ↩︎
105. Scott R. Levin et al., “Association of Medicaid Expansion with Tunneled Dialysis Catheter Use at the Time of First Arteriovenous Access Creation,” Annals of Vascular Surgery Epub ahead of print (January 2021), https://www.annalsofvascularsurgery.com/article/S0890-5096(21)00082-0/fulltext ↩︎
106. Lauren D. Nephew et al., “Association of State Medicaid Expansion with Racial/Ethnic Disparities in Liver Transplant Wait-listing in the United States,” Jama Network Open 3 no. 10 (October 2020), https://doi.org/10.1001/jamanetworkopen.2020.19869 ↩︎
107. Melissa McInerney, Ruth Winecoff, Padmaja Ayyagari, Kosali Simon, and M. Kate Bundorf, “ACA Medicaid Expansion Associated With Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence From the Health and Retirement Study,” Inquiry: The Journal of Health Care Organization, Provision, and Financing 57 (July 2020): 1-10, https://doi.org/10.1177/0046958020935229 ↩︎
108. Hiroshi Gotanda, Gerald F. Kominski, David Elashoff, and Yusuke Tsugawa, “Association Between the ACA Medicaid Expansions and Changes in Cardiovascular Risk Factors Among Low-Income Individuals,” Journal of General Internal Medicine Epub ahead of print (January 2021), https://doi.org/10.1007/s11606-020-06417-6 ↩︎
109. Smriti Rajita Kumar, Sameed Ahmed M. Khatana, and David Goldberg, “Impact of Medicaid Expansion on Liver-Related Mortality,” Clinical Gastroenterology and Hepatology Epub ahead of print (December 2020), https://doi.org/10.1016/j.cgh.2020.11.042 ↩︎
110. Sadiya S. Khan, Donald M. Lloyd Jones, Mercedes Carnethon, Lindsay R. Pool, “Medicaid Expansion and State-Level Differences in Premature Cardiovascular Mortality by Subtype, 2010–2017,” Hypertension 76 (September 2020): 37-38, https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.15968 ↩︎
111. Heather Angier et al., “Role of Health Insurance and Neighborhood-Level Social Deprivation on Hypertension Control Following the Affordable Care Act Health Insurance Opportunities,” Social Science & Medicine 265 Epub ahead of print (November 2020), https://doi.org/10.1016/j.socscimed.2020.113439 ↩︎
112. Andrew Sumarsono et al., “Association of Medicaid Expansion with Rates of Utilization of Cardiovascular Therapies among Medicaid Beneficiaries Between 2011 and 2018,” Circulation: Cardiovascular Quality and Outcomes 14 no. 1 (January 2021), https://doi.org/10.1161/CIRCOUTCOMES.120.007492 ↩︎
113. Sameed Ahmed M. Khatana et al., “Medicaid Expansion and Ventricular Assist Device Implantation,” Journal of the American College of Cardiology 76 no. 12 (September 2020):1501-1502, https://www.sciencedirect.com/science/article/abs/pii/S0735109720361064?via%3Dihub ↩︎
114. Khadijah Breathett et al., “Is the Affordable Care Act Medicaid Expansion Linked to Change in Rate of Ventricular Assist Device Implantation for Blacks and Whites?” Circulation: Heart Failure 13, no. 4 (April 2020), https://doi.org/10.1161/CIRCHEARTFAILURE.119.006544 ↩︎
115. Xiaowen Wang, Alina A. Luke, Justin M. Vader, Thomas M. Maddox, and Karen E. Joynt Maddox, “Disparities and Impact of Medicaid Expansion on Left Ventricular Assist Device Implantation and Outcomes,” Circulation: Cardiovascular Quality and Outcomes 13 no. 6 (June 2020), https://doi.org/10.1161/CIRCOUTCOMES.119.006284 ↩︎
116. Afshin Ehsan et al., “Cardiac Surgery Utilization Across Vulnerable Persons After Medicaid Expansion,” (2020), The Annals of Thoracic Surgery Epub ahead of print (November 2020), https://doi.org/10.1016/j.athoracsur.2020.08.066 ↩︎
117. Heather Angier et al., “New Hypertension and Diabetes Diagnoses Following the Affordable Care Act Medicaid Expansion,” Family Medicine and Community Health 8 no. 4 (December 2020), https://fmch.bmj.com/content/8/4/e000607 ↩︎
118. Heather Angier et al., “The Affordable Care Act Improved Health Insurance Coverage and Cardiovascular-Related Screening Rates for Cancer Survivors Seen in Community Health Centers,” Cancer 126 no. 14 (July 2020): 3303-3311, https://doi.org/10.1002/cncr.32900 ↩︎
119. Daniel B. Nelson et al., “Changes in Coverage, Access, and Health Following Implementation of Healthy Behavior Incentive Medicaid Expansions vs. Traditional Medicaid Expansions,” Journal of General Internal Medicine 35 (September 2020): 2521–2528, https://doi.org/10.1007/s11606-020-05801-6 ↩︎
120. Sri Lekha Tummalapalli and Salomeh Keylani, “Changes in Preventative Health Care After Medicaid Expansion,” Medical Care 58 no. 6 (June 2020): 549-556, https://doi.org/doi:10.1001/jamanetworkopen.2020.18728 ↩︎
121. Aparna Soni, “The Effects of Public Health Insurance on Health Behaviors: Evidence From the Fifth Year of Medicaid Expansion,” Health Economics 29 no. 12 (December 2020): 1586-1605, https://doi.org/10.1002/hec.4155 ↩︎
122. Rebecca Myerson, Samuel Crawford, and Laura R. Wherry, “Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, And Postpartum Contraception,” Health Affairs 39 no. 11 (November 2020): 1883-1890, https://doi.org/10.1377/hlthaff.2020.00106 ↩︎
123. Melissa McInerney and Mark K. Meiselbach, “Distributional Effects of Recent Health Insurance Expansions on Weight-Related Outcomes,” Economics & Human Biology 38, Epub ahead of print (August 2020), https://doi.org/10.1016/j.ehb.2020.100870 ↩︎
124. Molly O’Malley Watts, MaryBeth Musumeci, and Priya Chidambaram, State Variation in Medicaid LTSS Policy Choices and Implications for Upcoming Policy Debates (Washington, DC: KFF, February 2021), https://modern.kff.org/report-section/state-variation-in-medicaid-ltss-policy-choices-and-implications-for-upcoming-policy-debates-issue-brief/ ↩︎
125. Stephan Lindner, Anna Levy, and Willi Horner-Johnson, “The Medicaid Expansion Did Not Crowd Out Access for Medicaid Recipients With Disabilities in Oregon,” Disability and Health Journal (Novermber 2020), https://doi.org/10.1016/j.dhjo.2020.101010 ↩︎
126. Maria E. Torres, Benjamin D. Capistrant, and Hannah Karpman, “The Effect of Medicaid Expansion on Caregiver’s Quality of Life,” Social Work in Public Health 35 no. 6 (August 2020): 473-482, https://doi.org/10.1080/19371918.2020.1798836 ↩︎
127. Bradley Heim, Ithai Lurie, Kathleen J.Mullen, and Kosali Simon, “How Much Do Outside Options Matter? The Effect of Subsidized Health Insurance on Social Security Disability Insurance Benefit Receipt,” Journal of Health Economics 76 Epub ahead of print (January 2021), https://doi.org/10.1016/j.jhealeco.2021.102437 ↩︎
128. Purvi Sevak and Jodi Schimmel Hyde, “The ACA Medicaid Expansions and Employment of Adults With Disabilities,” Journal of Disability Policy Studies Epub ahead of print (July 2020), https://doi.org/10.1177/1044207320943554 ↩︎
129. Rebecca Myerson, Samuel Crawford, Laura R. Wherry, “Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, And Postpartum Contraception,” Health Affairs 39 no. 11 (November 2020): 1883-1890, https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00106 ↩︎
130. Tyler N. A. Winkelman et al., “Medications for Opioid Use Disorder among Pregnant Women Referred by Criminal Justice Agencies before and after Medicaid Expansion: A Retrospective Study of Admissions to Treatment Centers in the United States,” PLOS Medicine 17 no. 5 (May 2020), https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003119 ↩︎
131. S. Marie Harvey et al., “Impact of Medicaid Expansion in Oregon on Access to Prenatal Care,” Preventative Medicine 143 (February 2021), https://www.sciencedirect.com/science/article/abs/pii/S0091743520303911?via%3Dihub ↩︎
132. Makayla Palmer, “Preconception Subsidized Insurance: Prenatal Care and Birth Outcomes by Race/Ethnicity,” Health Economics 29 no. 9 (September 2020): 1013-1030, https://doi.org/10.1002/hec.4116 ↩︎
133. Wei Lyu and George L. Wehby, “Heterogeneous Effects of Affordable Care Act Medicaid Expansions Among Women with Dependent Children by State-Level Pre-Expansion Eligibility,” Journal of Women’s Health Epub ahead of print (Februrary 2021), https://doi.org/10.1089/jwh.2020.8776 ↩︎
134. Erica Eliason, “Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality,” Women’s Health Issues 30, no. 3 (May-June 2020): 147-152, https://doi.org/10.1016/j.whi.2020.01.005 ↩︎
135. Jean Guglielminotti, Ruth Landau, and Guohua Li, “The 2014 New York States Medicaid Expansion and Severe Maternal Morbidity,” Anesthesia and Analgesia 10 (January 2021), https://journals.lww.com/anesthesia-analgesia/Abstract/9900/The_2014_New_York_State_Medicaid_Expansion_and.64.aspx ↩︎
136. S. Marie Harvey, Lisa P. Oakley, Susannah E. Gibbs, Shyama Mahakalanda, Jeff Luck, and Jangho Yoon, “Impact of Medicaid Expansion in Oregon on Access to Prenatal Care,” Preventative Medicine 143 (February 2021), https://www.sciencedirect.com/science/article/pii/S0091743520303911?via%3Dihub ↩︎
137. Alexandra Wiggins, Ibraheem M. Karaye, Jennifer A. Horney, “Medicaid Expansion and Infant Mortality, Revisited: A Difference-In-Differences Analysis,” Health Services Research 55, no. 3 (March 2020): 393-398, https://doi.org/10.1111/1475-6773.13286 ↩︎
138. Clare Brown, Jennifer Moore, Felix Holly, Kathryn Stewart, and Mick Tilford, “County-level Variation in Low Birthweight and Preterm Birth: An Evaluation of State Medicaid Expansion Under the Affordable Care Act,” Medical Care 58, no. 6 (June 2020): 497-503, https://doi.org/10.1097/mlr.0000000000001313 ↩︎
139. Amanda Cooke and Amanda Stype, “Medicaid Expansion and Infant Mortality: The (Questionable) Impact of the Affordable Care Act,” Journal of Epidemiology and Community Health 75 no. 1 (January 2021): 10-15, https://jech.bmj.com/content/75/1/10 ↩︎
140. Claire E. Margerison, Robert Kestner, Jiajia Chen, Collen MacCullum-Bridges, “Impacts of Medicaid Expansion Prior to Conception on Pre-pregnancy Health, Pregnancy Health, and Outcomes,” American Journal of Epidemiology Epub ahead of print (January 2021), https://academic.oup.com/aje/advance-article/doi/10.1093/aje/kwaa289/6071895 ↩︎
141. Kristen S. Marchi, Melanie S. Dove, Katherine E. Heck, Chuncui Fan, “The Affordable Care Act and Changes in Women’s Health Insurance Coverage Before, During, and After Pregnancy in California,” Public Health Reports, 136 no. 1 (October 2020): 70-78, https://journals.sagepub.com/doi/10.1177/0033354920962798#articleCitationDownloadContainer ↩︎
142. Rebecca Myerson, Samuel Crawford, Laura R. Wherry, “Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, And Postpartum Contraception,” Health Affairs 39 no. 11 (November 2020): 1883-1890, https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00106 ↩︎
143. Lucy Chen, Richard G. Frank, and Haiden A. Huskamp, “Overturning the ACA’s Medicaid Expansion Would Likely Decrease Low-Income, Reproductive-Age Women’s Healthcare Spending and Utilization,” Inquiry: The Journal of Health Care Organization, Provision, and Financing 57 (December 2020), https://journals.sagepub.com/doi/10.1177/0046958020981462 ↩︎
144. Emily M. Johnston, Stacey McMorrow, Tyler Thomas, and Genevieve M. Kenney, “ACA Medicaid Expansion and Insurance Coverage among New Mothers Living in Poverty,” Pediatrics 145 no. 5 (May 2020), https://pediatrics.aappublications.org/content/145/5/e20193178 ↩︎
145. Jamie R. Daw, Tyler N. A. Winkelman, Vanessa K. Dalton, Katy B. Kozhimannil, and Lindsay K. Admon, “Medicaid Expansion Improved Perinatal Insurance Continuity For Low-Income Women” Health Affairs 39 no. 9 (September 2020), https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.01835 ↩︎
146. Anne L. Dunlop, Peter Joski, Andrea E. Strahan, Erica Sierra, and Kathleen Adams, “Postpartum Medicaid Coverage and Contraceptive Use Before and After Ohio’s Medicaid Expansion Under the Affordable Care Act,” Women’s Health Issues 30 no. 6 (November 2020): 426–435, https://doi.org/10.1016/j.whi.2020.08.006 ↩︎
147. S. Marie Harvey et al., “Impact of Medicaid Expansion in Oregon on Access to Prenatal Care,” Preventative Medicine 143 (February 2021), https://www.sciencedirect.com/science/article/abs/pii/S0091743520303911?via%3Dihub ↩︎
148. Jean Guglielminotti, Ruth Landau, and Guohua Li, “The 2014 New York States Medicaid Expansion and Severe Maternal Morbidity,” Anesthesia and Analgesia 10 (January 2021), https://journals.lww.com/anesthesia-analgesia/Abstract/9900/The_2014_New_York_State_Medicaid_Expansion_and.64.aspx ↩︎
149. Makayla Palmer, “Preconception Subsidized Insurance: Prenatal Care and Birth Outcomes by Race/Ethnicity,” Health Economics 29 no. 9 (September 2020): 1013-1030, https://doi.org/10.1002/hec.4116 ↩︎
150. Rebecca Myerson, Samuel Crawford, Laura R. Wherry, “Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, And Postpartum Contraception,” Health Affairs 39 no. 11 (November 2020): 1883-1890, https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00106 ↩︎
151. Blair G. Darney et al., “Evaluation of Medicaid Expansion Under the Affordable Care Act and Contraceptive Care in US Community Health Centers,” JAMA Network Open 3 no. 6 (June 2020), https://doi.org/10.1001/jamanetworkopen.2020.6874 ↩︎
152. Anne L. Dunlop, Peter Joski, Andrea E. Strahan, Erica Sierra, and Kathleen Adams, “Postpartum Medicaid Coverage and Contraceptive Use Before and After Ohio’s Medicaid Expansion Under the Affordable Care Act,” Women’s Health Issues 30 no. 6 (November 2020): 426–435, https://doi.org/10.1016/j.whi.2020.08.006 ↩︎
153. Andrew Sumarsono et al., “Medicaid Expansion and Provision of Prescription Contraception to Medicaid Beneficiaries,” An Internal Reproductive Health Journal: Contraception Epub ahead of print (November 2020), https://www.contraceptionjournal.org/article/S0010-7824(20)30415-7/fulltext ↩︎
154. Susannah E. Gibbs, S. Marie Harvey, Annie Larson, Jangho Yoon, and Jeff Luck, “Contraceptive Services After Medicaid Expansion in a State with a Medicaid Family Planning Waiver Program,” Journal of Women’s Health Epub ahead of print (October 2020), https://doi.org/10.1089/jwh.2020.8351 ↩︎
155. Blair G. Darney et al., “Payment for Contraceptive Services in Safety Net Clinics: Roles of Affordable Care Act, Title X, and State Programs,” Medical Care 58 no. 5 (May 2020): 453-460, https://doi.org/10.1097/mlr.0000000000001309 ↩︎
156. Anitha Menon, Payal K. Patel, Monita Karmakar, and Renuka Tipirneni, “The Impact of the Affordable Care Act Medicaid Expansion on Racial/Ethnic and Sex Disparities in HIV Testing: National Findings fromthe Behavioral Risk Factor Surveillance System,” Journal of General Internal Medicine Epub ahead of print (January 2021), https://doi.org/10.1007/s11606-021-06590-2 ↩︎
157. Sri Lekha Tummalapalli and Salomeh Keylani, “Changes in Preventative Health Care After Medicaid Expansion,” Medical Care 58 no. 6 (June 2020): 549-556, https://journals.lww.com/lww-medicalcare/Abstract/2020/06000/Changes_in_Preventative_Health_Care_After_Medicaid.8.aspx ↩︎
158. Aparna Soni, “The Effects of Public Health Insurance on Health Behaviors: Evidence From the Fifth Year of Medicaid Expansion,” Health Economics 29 no. 12 (December 2020): 1586-1605, https://doi.org/10.1002/hec.4155 ↩︎
159. Bita Fayaz Farkhad, David R. Holtgrave, and Dolores Albarracín, “Effect of Medicaid Expansions on HIV Diagnoses and Pre-Exposure Prophylaxis Use,” American Journal of Preventive Medicine Epub ahead of print (January 2021), https://doi.org/10.1016/j.amepre.2020.10.021 ↩︎
160. Daniel B. Nelson et al., “Changes in Coverage, Access, and Health Following Implementation of Healthy Behavior Incentive Medicaid Expansions vs. Traditional Medicaid Expansions,” Journal of General Internal Medicine 35 (September 2020): 2521–2528, https://doi.org/10.1007/s11606-020-05801-6 ↩︎
161. Brigit Hatch et al., “Impacts of the Affordable Care Act on Receipt of Women’s Preventive Services in Community Health Centers in Medicaid Expansion and Nonexpansion States,” Women’s Health Issues 31 no. 1 (January 2021): 9-16, https://www.whijournal.com/article/S1049-3867(20)30097-9/fulltext ↩︎
162. Rashunda Lewis et al., “Healthcare Access and Utilization Among Persons Who Inject Drugs in Medicaid Expansion and Nonexpansion States: 22 United States Cities, 2018,” The Journal of Infectious Diseases 222, no. 5 (October 2020): S420–S428, https://doi.org/10.1093/infdis/jiaa337 ↩︎
163. Amy R. Baugher et al., “Health Care Coverage and Preexposure Prophylaxis (PrEP) Use Among Men Who Have Sex With Men Living in 22 US Cities With vs Without Medicaid Expansion, 2017,” American Journal of Public Health Epub ahead of print (January 2021), https://doi.org/10.2105/ajph.2020.306035 ↩︎
164. Kathleen A. McManus, Karishma Srikanth, Samuel D. Powers, Rebecca Dillingham, and Elizabeth T. Rogawski McQuade, “Medicaid Expansion’s Impact on Human Immunodeficiency Virus Outcomes in a Nonurban Southeastern Ryan White HIV/AIDS Program Clinic,” Open Forum Infectious Diseases 8 no. 2 (February 2021), https://doi.org/10.1093/ofid/ofaa595 ↩︎
165. Dimitris Karlestos and Charles Stoecker, “Impact of Medicaid Expansion on PrEP Utilization in the US: 2012–2018” AIDS and Behavior Epub ahead of print. (October 2020), https://link.springer.com/article/10.1007/s10461-020-03070-2#citeas ↩︎
166. Kathleen A. McManus, Joshua Ferey, Elizabeth Farrell, and Rebecca Dillingham, “National Survey of US HIV Clinicians: Knowledge and Attitudes About the Affordable Care Act and Opinions of its Impact on Quality of Care and Barriers to Care,” Open Forum Infectious Diseases 7, no. 7 (July 2020), https://doi.org/10.1093/ofid/ofaa225 ↩︎
167. Stephen Bonett, Steven Meanley, Steven Elsesser, and José Bauermeister, “State-Level Discrimination Policies And HIV Pre-Exposure Prophylaxis Adoption Efforts In The US,” Health Affairs 39 no. 9 (September 2020): 1575-1582, https://doi.org/10.1377/hlthaff.2020.00242 ↩︎
168. Mark Olfson et al., “Medicaid Expansion and Low-Income Adults with Substance Use Disorders,” The Journal of Behavioral Health Services and Research Epub ahead of print (November 2020), https://link.springer.com/article/10.1007/s11414-020-09738-w ↩︎
169. Rashunda Lewis et al., “Healthcare Access and Utilization Among Persons Who Inject Drugs in Medicaid Expansion and Nonexpansion States: 22 United States Cities, 2018,” The Journal of Infectious Diseases 222, no. 5 (October 2020): S420–S428, https://doi.org/10.1093/infdis/jiaa337 ↩︎
170. Minji Sohn et al., “Association Between State Medicaid Expansion Status And Naloxone Prescription Dispensing” Health Services Research 55 no. 2 (February 2020): 239-248, https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.13266 ↩︎
171. Brendan Saloner and Johanna Catherine Maclean, “Specialty Substance Use Disorder Treatment Admissions Steadily Increased In The Four Years After Medicaid Expansion,” Health Affairs 39 no. 3 (March 2020): 453–461, https://doi.org/10.1377/hlthaff.2019.01428 ↩︎
172. Hefei Wen et. al, “Association Between Medicaid Expansion and Rates of Opioid-Related Hospital Use,” JAMA Internal Medicine 180 no. 5 (May 2020): 753-759, https://doi.org/10.1001/jamainternmed.2020.0473 ↩︎
173. George Pro, Jeff Utter, Shane Haberstroh, and Julie A. Baldwin, “Dual Mental Health Diagnoses Predict the Receipt of Medication-Assisted Opioid Treatment: Associations Moderated By State Medicaid Expansion Status, Race/Ethnicity and Gender, and Year,” Drug and Alcohol Dependence 209 (April 2020), https://doi.org/10.1016/j.drugalcdep.2020.107952 ↩︎
174. Iraklis Erik Tseregounis, James J. Gasper, and Stephen G. Henry, “Trends in Buprenorphine to Treat Opioid Use Disorder in California, 2012 to 2018: Medicaid Outpaces the Rest of the State,” Journal of Addiction Medicine Epub ahead of print (November 2020), https://doi.org/10.1097/ADM.0000000000000768 ↩︎
175. Tyler N. A. Winkelman et al., “Medications for Opioid Use Disorder among Pregnant Women Referred by Criminal Justice Agencies before and after Medicaid Expansion: A Retrospective Study of Admissions to Treatment Centers in the United States,” PLOS Medicine 17 no. 5 (May 2020), https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003119 ↩︎
176. Mark Olfson, Victoria Shu Zhang, Marissa King, and Ramin Mojtabai, “Changes in Buprenorphine Treatment After Medicaid Expansion,” Psychiatric Services Epub ahead of print (March 2021), https://doi.org/10.1176/appi.ps.202000491 ↩︎
177. Alex K. Gertner et al., “The Effect of Medicaid Expansion on Use of Opioid Agonist Treatment and the Role of Provider Capacity Constraints,” Health Services Research 55 no. 3 (June 2020): 383-392, https://doi.org/10.1111/1475-6773.13282 ↩︎
178. George Pro et al., “The Role of State Medicaid Expansions in Integrating Comprehensive Mental Health Services into Opioid Treatment Programs: Differences Across the Rural/Urban Continuum,” Community Mental Health Journal Epub ahead of print (October 2020), https://doi.org/10.1007/s10597-020-00719-z ↩︎
179. Amanda J. Abraham et al., “Medicaid Expansion and Availability of Opioid Medications in the Specialty Substance Use Disorder Treatment System,” Psychiatric Services 72 no. 2 (February 2021): 148-155: https://doi.org/10.1176/appi.ps.202000049 ↩︎
180. Rahi Abouk, Lorens Helmchen, Ali Moghtaderi, and Jesse Pines, “The ACA Medicaid Expansions and Opioid Mortality: Is There a Link?,” Medical Care Research and Review Epub ahead of print (October 2020), https://doi.org/10.1177/1077558720967227 ↩︎
181. Brandon W. Yan, Frank A. Sloan, W. John Boscardin, Felicia Guo, and R. Adams Dudley, “The Opioid Epidemic Blunted the Mortality Benefit of Medicaid Expansion,” Medical Care Research and Review Epub ahead of print (May 2020), https://journals.sagepub.com/doi/10.1177/1077558720919620 ↩︎
182. Alisha Monnette, Charles Stoecker, Elizabeth Nauman, and Lizheng Shi, “The Impact of Medicaid Expansion on Access to Care and Preventative Care for Adults with Diabetes and Depression,” Journal of Diabetes and its Complications 34 no. 10 (October 2020), https://doi.org/10.1016/j.jdiacomp.2020.107663 ↩︎
183. Elson Oshman Blunt, Johanna Catherine Maclean, Ioana Popovici, and Steven C. Marcus, “Public Insurance Expansions and Mental Health Care Availability,” Health Services Research 55 no. 4 (August 2020): 615-625, https://doi.org/10.1111/1475-6773.13311 ↩︎
184. Amelia Harju and Jonathan Neufeld, “The Impact of Medicaid Expansion on Telemental Health Utilization in Four Midwestern States,” Telemedicine and e-Health Epub ahead of print (January 2021), https://www.liebertpub.com/doi/10.1089/tmj.2020.0476 ↩︎
185. Benjamin W. Cowan and Zhuang Hao, Medicaid Expansion and the Mental Health of College Students (National Bureau of Economic Research, Working Paper No. 27306, June 2020), https://www.nber.org/papers/w27306 ↩︎
186. George Pro, Jeff Utter, Shane Haberstroh, and Julie A. Baldwin, “Dual Mental Health Diagnoses Predict the Receipt of Medication-Assisted Opioid Treatment: Associations Moderated By State Medicaid Expansion Status, Race/Ethnicity and Gender, and Year,” Drug and Alcohol Dependence 209 (April 2020), https://doi.org/10.1016/j.drugalcdep.2020.107952 ↩︎
187. Robert Rosales, David Takeuchi, and Rocío Calvo, “After the Affordable Care Act: the Effects of the Health Safety Net and the Medicaid Expansion on Latinxs’ Use of Behavioral Healthcare in the US,” The Journal of Behavioral Health Services & Research Epub ahead of print (June 2020), https://doi.org/10.1007/s11414-020-09715-3 ↩︎
188. Joshua Breslau, Bing Han, Julie Lai, and Hao Yu, “Impact of the Affordable Care Act Medicaid Expansion on Utilization of Mental Health Care,” Medical Care 58 no. 9 (September 2020): 757-762, https://doi.org/10.1097/MLR.0000000000001373 ↩︎
189. George Pro et al., “The Role of State Medicaid Expansions in Integrating Comprehensive Mental Health Services into Opioid Treatment Programs: Differences Across the Rural/Urban Continuum,” Community Mental Health Journal Epub ahead of print (October 2020), https://doi.org/10.1007/s10597-020-00719-z ↩︎
190. Hefei Wen et. al, “Association Between Medicaid Expansion and Rates of Opioid-Related Hospital Use,” JAMA Internal Medicine 180 no. 5 (May 2020): 753-759, https://doi.org/10.1001/jamainternmed.2020.0473 ↩︎
191. Rebecca Myerson, Samuel Crawford, Laura R. Wherry, “Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, And Postpartum Contraception,” Health Affairs 39 no. 11 (November 2020): 1883-1890, https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00106 ↩︎
192. Melissa McInerney, Ruth Winecoff, Padmaja Ayyagari, Kosali Simon, and M. Kate Bundorf, “ACA Medicaid Expansion Associated With Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence From the Health and Retirement Study,” Inquiry: The Journal of Health Care Organization, Provision, and Financing 57 (July 2020): 1-10, https://doi.org/10.1177/0046958020935229 ↩︎
193. Kevin N. Griffith and Jacob H. Bor, “Changes in Health Care Access, Behaviors, and Self-reported Health Among Low-income US Adults Through the Fourth Year of the Affordable Care Act,” Medical Care 58, no. 6 (June 2020): 574-578, https://doi.org/10.1097/MLR.0000000000001321 ↩︎
194. Bryce Ward, The Impact of Medicaid Expansion on States’ Budgets (The Commonwealth Fund, May 2020), https://www.commonwealthfund.org/publications/issue-briefs/2020/may/impact-medicaid-expansion-states-budgets ↩︎
195. Jonathan Gruber and Benjamin D. Sommers, Fiscal Federalism and the Budget Impacts of the Affordable Care Act’s Medicaid Expansion (National Bureau of Economic Research, Working Paper No. 26862, March 2020), https://www.nber.org/papers/w26862 ↩︎
196. Madeline Guth, Bradley Corallo, Robin Rudowitz, and Rachel Garfield, Medicaid Expansion Enrollment and Spending Leading up to the COVID-19 Pandemic (Washington, DC: KFF, January 2021), https://modern.kff.org/medicaid/issue-brief/medicaid-expansion-enrollment-and-spending-leading-up-to-the-covid-19-pandemic/ ↩︎
197. Brendan Saloner and Johanna Catherine Maclean, “Specialty Substance Use Disorder Treatment Admissions Steadily Increased In The Four Years After Medicaid Expansion,” Health Affairs 39 no. 3 (March 2020): 453–461, https://doi.org/10.1377/hlthaff.2019.01428 ↩︎
198. Mark Borgschulte and Jacob VoglerbaI, “Did the ACA Medicaid Expansion Save Lives?,” Journal of Health Economics 72 (July 2020), https://doi.org/10.1016/j.jhealeco.2020.102333 ↩︎
199. Saunders Lin, Karen J. Brasel, Ougni Chakraborty, and Sherry A. Glied, “Association Between Medicaid Expansion and the Use of Outpatient General Surgical Care Among US Adults in Multiple States,” JAMA Surgery 155 no. 11 (November 2020): 1058-1066, https://jamanetwork.com/journals/jamasurgery/article-abstract/2769588 ↩︎
200. Justin Le Blanc, Danielle Heller, Ann Friedrich, Donald Lannin, and Tristen Park, “Association of Medicaid Expansion Under the Affordable Care Act With Breast Cancer Stage at Diagnosis,” JAMA Surgery (July 2020), https://doi.org/10.1001/jamasurg.2020.1495 ↩︎
201. Adrian Diaz, Daniel Chavarin, Anghela Z. Paredes, and Timothy M. Pawlik, “Utilization of High-Volume Hospitals for High-Risk Cancer Surgery in California Following Medicaid Expansion,” Journal of Gastrointestinal Surgery Epub ahead of print (July 2020), https://link.springer.com/article/10.1007/s11605-020-04747-8 ↩︎
202. Johanna Catherine Maclean, Michael T. Halpern, Steven C. Hill, and Michael F. Pesko, “The Effect of Medicaid Expansion on Prescriptions for Breast Cancer Hormonal Therapy Medications,” Health Services Research, 55 no. 3 (April 2020): 399-410, https://doi.org/10.1111/1475-6773.13289 ↩︎
203. Tyler R. McClintock et al., “Association of Affordable Care Act-Related Medicaid Expansion with Variation in Utilization of Surgical Services,” The American Journal of Surgery, 220 no. 2 (August 2020): 441-447, https://doi.org/10.1016/j.amjsurg.2019.12.017 ↩︎
204. Ali Moghtaderi et al., “The Three-Year Effect of Medicaid Expansion on Emergency Department Visits and Admissions,” Annals of Emergency Medicine An International Journal 77 no. 1, (January 2021): 76-81, https://doi.org/10.1016/j.annemergmed.2020.07.021 ↩︎
205. Kathleen A. McManus, Karishma Srikanth, Samuel D. Powers, Rebecca Dillingham, and Elizabeth T. Rogawski McQuade, “Medicaid Expansion’s Impact on Human Immunodeficiency Virus Outcomes in a Nonurban Southeastern Ryan White HIV/AIDS Program Clinic,” Open Forum Infectious Diseases 8 no. 2 (February 2021), https://doi.org/10.1093/ofid/ofaa595 ↩︎
206. Jamie Oh et al., “Impact of the Affordable Care Act’s Medicaid Expansion on Burn Outcomes and Disposition,” Burns 47 no. 1 (February 2021): 35-41, https://doi.org/10.1016/j.burns.2020.10.030 ↩︎
207. Fredric Blavin and Christal Ramos, “Medicaid Expansion: Effects On Hospital Finances And Implications For Hospitals Facing COVID-19 Challenges,” Health Affairs 40 no. 1 (January 2021): 82-90, https://doi.org/10.1377/hlthaff.2020.00502 ↩︎
208. Minji Sohn et al., “Association Between State Medicaid Expansion Status And Naloxone Prescription Dispensing” Health Services Research 55 no. 2 (February 2020): 239-248, https://doi.org/10.1111/1475-6773.13266 ↩︎
209. Wafa W. Tarazi, “Associations Between Medicaid Expansion and Nurse Staffing Ratios and Hospital Readmissions,” Health Services Research 55 no. 3 (June 2020): 375-382, https://doi.org/10.1111/1475-6773.13273 ↩︎
210. Brendan Saloner and Johanna Catherine Maclean, “Specialty Substance Use Disorder Treatment Admissions Steadily Increased In The Four Years After Medicaid Expansion,” Health Affairs 39 no. 3 (March 2020): 453–461, https://doi.org/10.1377/hlthaff.2019.01428 ↩︎
211. Jason Tong et al., “The Impact of the Affordable Care Act on Surgeon Selection Amongst Colorectal Surgery Patients,” The American Journal of Surgery Epub ahead of print (February 2021), https://doi.org/10.1016/j.amjsurg.2021.01.041 ↩︎
212. Erica M. Valdovinos, Matthew J. Niedzwiecki, Joanna Guo, and Renee Y. Hsia, “Effects of Medicaid Expansion on Access, Treatment and Outcomes for Patients with Acute Myocardial Infarction,” PLOS ONE 15 no. 4 (April 2020), https://doi.org/10.1371/journal.pone.0232097 ↩︎
213. Erica M. Valdovinos, Matthew J. Niedzwiecki, Joanna Guo, and Renee Y. Hsia, “The Association of Medicaid Expansion and Racial/Ethnic Inequities in Access, Treatment, and Outcomes for Patients with Acute Myocardial Infarction,” PLOS ONE 15 no. 11 (November 2020), https://doi.org/10.1371/journal.pone.0241785 ↩︎
214. Hefei Wen et. al, “Association Between Medicaid Expansion and Rates of Opioid-Related Hospital Use,” JAMA Internal Medicine 180 no. 5 (May 2020): 753-759, https://doi.org/10.1001/jamainternmed.2020.0473 ↩︎
215. Monique Barakat et al., “Recent Trends and the Impact of the Affordable Care Act on Emergency Department Visits and Hospitalizations for Gastrointestinal, Pancreatic, and Liver Diseases,” Journal of Clinical Gastroenterology 54 no. 3 (March 2020), https://doi.org/10.1097/MCG.0000000000001102 ↩︎
216. Ezra S. Brooks et al., “The Effects of the Affordable Care Act on Access and Outcomes of Colon Surgery,” The American Journal of Surgery Epub ahead of print (January 2021), https://doi.org/10.1016/j.amjsurg.2021.01.019 ↩︎
217. Blair G. Darney et al., “Payment for Contraceptive Services in Safety Net Clinics: Roles of Affordable Care Act, Title X, and State Programs,” Medical Care 58 no. 5 (May 2020): 453-460, https://doi.org/10.1097/mlr.0000000000001309 ↩︎
218. Scott R. Levin et al., “Association of Medicaid Expansion with Tunneled Dialysis Catheter Use at the Time of First Arteriovenous Access Creation,” Annals of Vascular Surgery Epub ahead of print (January 2021), https://www.annalsofvascularsurgery.com/article/S0890-5096(21)00082-0/fulltext ↩︎
219. Pooja S. Yesantharao et al., “The Impact of Policy Reform on Utilization of Popular Reconstructive Procedures,” Annals of Plastic Surgery Epub ahead of print (December 2020), https://doi.org/10.1097/SAP.0000000000002608 ↩︎
220. Laurent C. Glance, Caroline P. Thirukumaran, Ernie Shippey, Stewart J. Lustik, and Andrew W. Dick, “Impact of Medicaid Expansion on Disparities in Revascularization in Patients Hospitalized with Acute Myocardial Infarction,” PLOS One Epub ahead of print (December 2020), https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243385 ↩︎
221. Lisa Marie Knowlton et al., “The Impact of Medicaid Expansion on Trauma-Related Emergency Department Utilization: A National Evaluation of Policy Implications,” The Journal of Trauma and Acute Care Surgery 88 no.1 (January 2020): 59-69, https://journals.lww.com/jtrauma/Abstract/2020/01000/The_impact_of_Medicaid_expansion_on_trauma_related.8.aspx ↩︎
222. Uriel Kim, Siran Koroukian, Abby Statler, and Johnie Rose, “The Effect of Medicaid Expansion Among Adults from Low-Income Communities on Stage at Diagnosis in Those with Screening-Amenable Cancers,” Cancer 126, no. 18 (September 2020): 4209-4219, https://doi-org.proxy.library.cornell.edu/10.1002/cncr.32895 ↩︎
223. Dan Kirkpatrick, Margaret Dunn, and Rebecca Tuttle, “Breast Cancer Stage at Presentation in Ohio: The Effect of Medicaid Expansion and the Affordable Care Act,” The American surgeon 86, no. 3 (2020): 195–199, https://pubmed.ncbi.nlm.nih.gov/32223797/ ↩︎
224. Anne E.Larson, Megan Hoopes, Heather Angier, Miguel Marino, and Nathalie Huguet, “Private/marketplace Insurance in Community Health Centers 5 years Post-Affordable Care Act in Medicaid Expansion and Non-Expansion States,” Preventive Medicine 141 Epub ahead of print (December 2020), https://doi.org/10.1016/j.ypmed.2020.106271 ↩︎
225. Mark Olfson, Victoria Shu Zhang, Marissa King, and Ramin Mojtabai, “Changes in Buprenorphine Treatment After Medicaid Expansion,” Psychiatric Services Epub ahead of print (March 2021), https://doi.org/10.1176/appi.ps.202000491 ↩︎
226. Paula Chatterjee, Mingyu Qi, and Rachel M. Werner, “Association of Medicaid Expansion With Quality in Safety-Net Hospitals,” JAMA Internal Medicine Epub ahead of print (February 2021), https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2775956 ↩︎
227. Ali Moghtaderi, Jesse Pines, Mark Zocchi, and Bernard Black, “The Effect of Affordable Care Act Medicaid Expansion on Hospital Revenue,” Health Economics 29 no. 12 (December 2020): 1682-1704, https://doi.org/10.1002/hec.4157 ↩︎
228. Kevin Callison, Brigham Walker, Charles Stoecker, Jeral Self, and Mark L. Diana, “Medicaid Expansion Reduced Uncompensated Care Costs At Louisiana Hospitals; May Be A Model For Other States,” Health Affairs 40 no. 3 (March 2020): 529-535, https://doi.org/10.1377/hlthaff.2020.01677 ↩︎
229. Charles Stoecker, Mollye Demosthenidy, Yixue Shao, and Hugh Long, “Association of Nonprofit Hospitals’ Charitable Activities With Unreimbursed Medicaid Care After Medicaid Expansion,” JAMA Network Open 3 no. 2 (February 2020), https://doi.org/10.1001/jamanetworkopen.2020.0012 ↩︎
230. Kim Andrew and Zhao Liang, “Examining the Effects of the Medicaid Expansion on Uncompensated Care and DSH Payments,” Journal of Allied Health 49 no. 4 (Winter, 2020): 274-278, https://www.ingentaconnect.com/contentone/asahp/jah/2020/00000049/00000004/art00009?crawler=true&mimetype=application/pdf ↩︎
231. Paula Chatterjee, Mingyu Qi, and Rachel M. Werner, “Association of Medicaid Expansion With Quality in Safety-Net Hospitals,” JAMA Internal Medicine Epub ahead of print (February 2021), https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2775956 ↩︎
232. Lisa Marie Knowlton et al., “The Impact of Medicaid Expansion on Trauma-Related Emergency Department Utilization: A National Evaluation of Policy Implications,” The Journal of Trauma and Acute Care Surgery 88 no.1 (January 2020): 59-69, https://journals.lww.com/jtrauma/Abstract/2020/01000/The_impact_of_Medicaid_expansion_on_trauma_related.8.aspx ↩︎
233. Brad Wright et al., “Iowa’s Medicaid Healthy Behaviors Program Associated With Reduced Hospital-Based Care But Higher Spending, 2012–17,” Health Affairs 39 no. 5 (May 2020), https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.01145 ↩︎
234. Molly O’Malley Watts, MaryBeth Musumeci, and Priya Chidambaram, State Variation in Medicaid LTSS Policy Choices and Implications for Upcoming Policy Debates (Washington, DC: KFF, February 2021), https://modern.kff.org/report-section/state-variation-in-medicaid-ltss-policy-choices-and-implications-for-upcoming-policy-debates-issue-brief/ ↩︎
235. Andrew Sumarsono et al., “Medicaid Expansion and Utilization of Antihyperglycemic Therapies,” Diabetes Care 43 no. 11, (November 2020): 2684-2690, https://care.diabetesjournals.org/content/43/11/2684 ↩︎
236. Genevieve P. Kanter, Bardia Nabet, Meredith Matone, and David M. Rubin, “Association of State Medicaid Expansion With Hospital Community Benefit Spending,” Jama Network Open 3 no. 5 (May 2020), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766544 ↩︎
237. Fredric Blavin and Christal Ramos, “Medicaid Expansion: Effects On Hospital Finances And Implications For Hospitals Facing COVID-19 Challenges,” Health Affairs 40 no. 1 (January 2021): 82-90, https://doi.org/10.1377/hlthaff.2020.00502 ↩︎
238. Ali Moghtaderi, Jesse Pines, Mark Zocchi, and Bernard Black, “The Effect of Affordable Care Act Medicaid Expansion on Hospital Revenue,” Health Economics 29 no. 12 (December 2020): 1682-1704, https://doi.org/10.1002/hec.4157 ↩︎
239. Charles Stoecker, Mollye Demosthenidy, Yixue Shao, and Hugh Long, “Association of Nonprofit Hospitals’ Charitable Activities With Unreimbursed Medicaid Care After Medicaid Expansion,” JAMA Network Open 3 no. 2 (February 2020), https://doi.org/10.1001/jamanetworkopen.2020.0012 ↩︎
240. Tyler L. Malone, George H. Pink, and George M. Holmes, “Decline in Inpatient Volume at Rural Hospitals,” The Journal of Rural Health Epub ahead of print (December 2020), https://doi.org/10.1111/jrh.12553 ↩︎
241. David J. Wallace et al., “Association Between State Medicaid Expansion and Emergency Access to Acute Care Hospitals in the United States,” JAMA Network Open 3 no. 11 (November 2020), https://doi.org/10.1001/jamanetworkopen.2020.25815 ↩︎
242. Archana Babu et al., “The Affordable Care Act: Implications for Underserved Populations with Head & Neck Cancer,” American Journal of Otolaryngology 41, no. 4 (July-August 2020), https://doi.org/10.1016/j.amjoto.2020.102464 ↩︎
243. David Barrington et. al., “Where You Live Matters: A National Cancer Database Study of Medicaid Expansion and Endometrial Cancer Outcomes,” Gynecologic Oncology 158 no. 2 (August 2020): 407-414, https://doi.org/10.1016/j.ygyno.2020.05.018 ↩︎
244. Thomas Buchmueller and Helen Levy, “The ACA’s Impact On Racial And Ethnic Disparities In Health Insurance Coverage And Access To Care,” Health Affairs 39, no. 3 (March 2020): 395-402, https://doi.org/10.1377/hlthaff.2019.01394 ↩︎
245. Munira Z. Gunja et al, Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage (The Commonwealth Fund, July 2020), https://www.commonwealthfund.org/publications/issue-briefs/2020/jul/gap-closed-aca-impact-asian-american-coverage ↩︎
246. Anuj Gangopadhyaya and Emily M. Johnston, Impacts of the ACA’s Medicaid Expansion on Health Insurance Coverage and Health Care Access among Young Adults (Washington, D.C: The Urban Institute, February 21, 2021), https://www.urban.org/research/publication/impacts-acas-medicaid-expansion-health-insurance-coverage-and-health-care-access-among-young-adults/view/full_report ↩︎
247. Hawazin W. Elani, Benjamin D. Sommers, and Ichiro Kawachi, “Changes In Coverage And Access To Dental Care Five Years After ACA Medicaid Expansion,” Health Affairs 39 no. 11 (November 2020): 1900-1908, https://doi.org/10.1377/hlthaff.2020.00386 ↩︎
248. Wei Ye, and Javier M. Rodriguez, “Highly Vulnerable Communities and the Affordable Care Act: Health Insurance Coverage Effects, 2010–2018,” Social Science and Medicine 270 (February 2021), https://doi.org/10.1016/j.socscimed.2021.113670 ↩︎
249. Benjamin B. Albright et al., “Impact of Medicaid Expansion on Women with Gynecologic Cancer: a Difference-in-Difference Analysis,” American Journal of Obstetrics and Gynecology 224 no. 2 (February 2021): 1-17, https://doi.org/10.1016/j.ajog.2020.08.007 ↩︎
250. Barbara H. Braffett, “Health Care Coverage and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes: Results From the TODAY2 Study,” Diabetes Care 43, no. 10 (October 2020): 2469-2477, https://doi.org/10.2337/dc20-0760 ↩︎
251. Hyungjung Lee, Dominic Hodgkin, Michael P. Johnson, and Frank P. Worell, “Medicaid Expansion and Racial and Ethnic Disparities in Access to Health Care: Applying the National Academy of Medicine Definition of Health Care Disparities,” The Journal of Healthcare Organization, Provision, and Financing Epub ahead of print. (February 2021), https://journals.sagepub.com/doi/10.1177/0046958021991293 ↩︎
252. Janani Rajbhandari-Thappa, Donglang Zhang, Kara E. MacLeod, Kiran Thapa, “Impact of Medicaid Expansion on Insurance Coverage Rates Among Adult Populations with Low Income and by Obesity Status” The Obesity Society 28 no. 7 (April 2020): 1219-1223, https://doi.org/10.1002/oby.22793 ↩︎
253. Hyungjung Lee, Dominic Hodgkin, Michael P. Johnson, and Frank P. Worell, “Medicaid Expansion and Racial and Ethnic Disparities in Access to Health Care: Applying the National Academy of Medicine Definition of Health Care Disparities,” The Journal of Healthcare Organization, Provision, and Financing Epub ahead of print. (February 2021), https://journals.sagepub.com/doi/10.1177/0046958021991293 ↩︎
254. Nosayaba Osazuwa-Peters et al., “State Medicaid Expansion Status, Insurance Coverage and Stage at Diagnosis in Head and Neck Cancer Patients,” Oral Oncology 110 (November 2020), https://doi.org/10.1016/j.oraloncology.2020.104870 ↩︎
255. Archana Babu et al., “The Affordable Care Act: Implications for Underserved Populations with Head & Neck Cancer,” American Journal of Otolaryngology 41, no. 4 (July-August 2020), https://doi.org/10.1016/j.amjoto.2020.102464 ↩︎
256. Anitha Menon, Payal K. Patel, Monita Karmakar, and Renuka Tipirneni, “The Impact of the Affordable Care Act Medicaid Expansion on Racial/Ethnic and Sex Disparities in HIV Testing: National Findings fromthe Behavioral Risk Factor Surveillance System,” Journal of General Internal Medicine Epub ahead of print (January 2021), https://doi.org/10.1007/s11606-021-06590-2 ↩︎
257. Laurent C. Glance, Caroline P. Thirukumaran, Ernie Shippey, Stewart J. Lustik, and Andrew W. Dick, “Impact of Medicaid Expansion on Disparities in Revascularization in Patients Hospitalized with Acute Myocardial Infarction,” PLOS One Epub ahead of print (December 2020), https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243385 ↩︎
258. Makayla Palmer, “Preconception Subsidized Insurance: Prenatal Care and Birth Outcomes by Race/Ethnicity,” Health Economics 29 no. 9 (September 2020): 1013-1030, https://doi.org/10.1002/hec.4116 ↩︎
259. Scott R. Levin et al., “Association of Medicaid Expansion with Tunneled Dialysis Catheter Use at the Time of First Arteriovenous Access Creation,” Annals of Vascular Surgery Epub ahead of print (January 2021), https://www.annalsofvascularsurgery.com/article/S0890-5096(21)00082-0/fulltext ↩︎
260. Erica M. Valdovinos, Matthew J. Niedzwiecki, Joanna Guo, and Renee Y. Hsia, “The Association of Medicaid Expansion and Racial/Ethnic Inequities in Access, Treatment, and Outcomes for Patients with Acute Myocardial Infarction,” PLOS ONE 15 no. 11 (November 2020), https://doi.org/10.1371/journal.pone.0241785 ↩︎
261. Clare Brown, Jennifer Moore, Felix Holly, Kathryn Stewart, and Mick Tilford, “County-level Variation in Low Birthweight and Preterm Birth: An Evaluation of State Medicaid Expansion Under the Affordable Care Act,” Medical Care 58, no. 6 (June 2020): 497-503, https://doi.org/10.1097/mlr.0000000000001313 ↩︎
262. Miguel Marino et al., “Disparities in Biomarkers for Patients With Diabetes After the Affordable Care Act,” Medical Care 58 (June 2020), https://doi.org/10.1097/mlr.0000000000001257 ↩︎
263. Minal R. Patel et al., “Examination of Changes in Health Status Among Michigan Medicaid Expansion Enrollees From 2016 to 2017,” JAMA Network Open 3, no. 7 (July 2020), https://doi.org/10.1001/jamanetworkopen.2020.8776 ↩︎
264. S. Marie Harvey et al., “Impact of Medicaid Expansion in Oregon on Access to Prenatal Care,” Preventative Medicine 143 (February 2021), https://www.sciencedirect.com/science/article/abs/pii/S0091743520303911?via%3Dihub ↩︎
265. Robert Rosales, David Takeuchi, and Rocío Calvo, “After the Affordable Care Act: the Effects of the Health Safety Net and the Medicaid Expansion on Latinxs’ Use of Behavioral Healthcare in the US,” The Journal of Behavioral Health Services & Research Epub ahead of print (June 2020), https://doi.org/10.1007/s11414-020-09715-3 ↩︎
266. Lauren D. Nephew et al., “Association of State Medicaid Expansion with Racial/Ethnic Disparities in Liver Transplant Wait-listing in the United States,” Jama Network Open 3 no. 10 (October 2020), https://doi.org/10.1001/jamanetworkopen.2020.19869 ↩︎
267. Benjamin W. Cowan and Zhuang Hao, Medicaid Expansion and the Mental Health of College Students (National Bureau of Economic Research, Working Paper No. 27306, June 2020), https://www.nber.org/papers/w27306 ↩︎
268. Khadijah Breathett et al., “Is the Affordable Care Act Medicaid Expansion Linked to Change in Rate of Ventricular Assist Device Implantation for Blacks and Whites?” Circulation: Heart Failure 13, no. 4 (April 2020), https://doi.org/10.1161/CIRCHEARTFAILURE.119.006544 ↩︎
269. Lauren D. Nephew et al., “Association of State Medicaid Expansion with Racial/Ethnic Disparities in Liver Transplant Wait-listing in the United States,” Jama Network Open 3 no. 10 (October 2020), https://doi.org/10.1001/jamanetworkopen.2020.19869 ↩︎
270. Afshin Ehsan et al., “Cardiac Surgery Utilization Across Vulnerable Persons After Medicaid Expansion,” (2020), The Annals of Thoracic Surgery Epub ahead of print (November 2020), https://doi.org/10.1016/j.athoracsur.2020.08.066 ↩︎
271. Adrian Diaz, Daniel Chavarin, Anghela Z. Paredes, and Timothy M. Pawlik, “Utilization of High-Volume Hospitals for High-Risk Cancer Surgery in California Following Medicaid Expansion,” Journal of Gastrointestinal Surgery Epub ahead of print (July 2020), https://link.springer.com/article/10.1007/s11605-020-04747-8 ↩︎
272. Saunders Lin, Karen J. Brasel, Ougni Chakraborty, and Sherry A. Glied, “Association Between Medicaid Expansion and the Use of Outpatient General Surgical Care Among US Adults in Multiple States,” JAMA Surgery 155 no. 11 (November 2020): 1058-1066, https://jamanetwork.com/journals/jamasurgery/article-abstract/2769588 ↩︎
273. Adam B. Weiner et al., “Changes in Prostate-Specific Antigen at the Time of Prostate Cancer Diagnosis After Medicaid Expansion in Young Men,” Cancer 126 no. 14 (July 2020): 3229-3236, https://doi.org/10.1002/cncr.32930 ↩︎
274. Justin Le Blanc, Danielle Heller, Ann Friedrich, Donald Lannin, and Tristen Park, “Association of Medicaid Expansion Under the Affordable Care Act With Breast Cancer Stage at Diagnosis,” JAMA Surgery (July 2020), https://doi.org/10.1001/jamasurg.2020.1495 ↩︎
275. Erica Eliason, “Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality,” Women’s Health Issues 30, no. 3 (May-June 2020): 147-152, https://doi.org/10.1016/j.whi.2020.01.005 ↩︎
276. Alexandra Wiggins, Ibraheem M. Karaye, Jennifer A. Horney, “Medicaid Expansion and Infant Mortality, Revisited: A Difference-In-Differences Analysis,” Health Services Research 55, no. 3 (March 2020): 393-398, https://doi.org/10.1111/1475-6773.13286 ↩︎
277. Amanda Cooke and Amanda Stype, “Medicaid Expansion and Infant Mortality: The (Questionable) Impact of the Affordable Care Act,” Journal of Epidemiology and Community Health 75 no. 1 (January 2021): 10-15, http://dx.doi.org/10.1136/jech-2019-213666 ↩︎
278. Jason Semprini, Olufunmilayo Olopade, “Evaluating the Effect of Medicaid Expansion on Black/White Breast Cancer Mortality Disparities: A Difference-in-Difference Analysis.” JCO Global Oncology no. 6, (July 2020): 1178-1183, https://doi.org/10.1200/GO.20.00068 ↩︎
279. Miranda B. Lam, Jessica Phelan, John Orav, Ashish K. Jha, and Nancy L. Keating, “Medicaid Expansion and Mortality Among Patients With Breast, Lung, and Colorectal Cancer,” Jama Network Open 3 no. 11 (November 2020), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772535 ↩︎
280. Matthew Buettgens, Fredric Blavin, and Clare Pan, “The Affordable Care Act Reduced Income Inequality In The US,” Health Affairs 40 no. 1(January 2021): 121-129, https://doi.org/10.1377/hlthaff.2019.00931 ↩︎
281. Benjamin W. Cowan and Zhuang Hao, Medicaid Expansion and the Mental Health of College Students (National Bureau of Economic Research, Working Paper No. 27306, June 2020), https://www.nber.org/papers/w27306 ↩︎
282. Afshin Ehsan et al., “Cardiac Surgery Utilization Across Vulnerable Persons After Medicaid Expansion,” (2020), The Annals of Thoracic Surgery Epub ahead of print (November 2020), https://doi.org/10.1016/j.athoracsur.2020.08.066 ↩︎
283. Matthew Buettgens, Fredric Blavin, and Clare Pan, “The Affordable Care Act Reduced Income Inequality In The US,” Health Affairs 40 no. 1(January 2021): 121-129, https://doi.org/10.1377/hlthaff.2019.00931 ↩︎
284. Heather Angier et al., “Role of Health Insurance and Neighborhood-Level Social Deprivation on Hypertension Control Following the Affordable Care Act Health Insurance Opportunities,” Social Science & Medicine 265 Epub ahead of print (November 2020), https://doi.org/10.1016/j.socscimed.2020.113439 ↩︎
285. Anuj Gangopadhyaya and Emily M. Johnston, Impacts of the ACA’s Medicaid Expansion on Health Insurance Coverage and Health Care Access among Young Adults (Washington, D.C: The Urban Institute, February 21, 2021), https://www.urban.org/research/publication/impacts-acas-medicaid-expansion-health-insurance-coverage-and-health-care-access-among-young-adults/view/full_report ↩︎
286. Francesco Renna, Kosteas D. Vasilios, Dinkar Kuchibotla, “Inequality in Health Insurance Coverage Before and After the Affordable Care Act,” Health Economics 30 no. 2 (November 2020): 384-402, https://doi.org/10.1002/hec.4195 ↩︎
287. Nosayaba Osazuwa-Peters et al., “State Medicaid Expansion Status, Insurance Coverage and Stage at Diagnosis in Head and Neck Cancer Patients,” Oral Oncology 110 (November 2020), https://doi.org/10.1016/j.oraloncology.2020.104870 ↩︎
288. Benjamin B. Albright et al., “Impact of Medicaid Expansion on Women with Gynecologic Cancer: a Difference-in-Difference Analysis,” American Journal of Obstetrics and Gynecology 224 no. 2 (February 2021): 1-17, https://doi.org/10.1016/j.ajog.2020.08.007 ↩︎
289. Jeffrey Clemens, Drew McNichols, and Joseph J. Sabia, The Long-Run Effects of the Affordable Care Act: A Pre-Committed Research Design Over the COVID-19 Recession and Recovery (National Bureau of Economic Research, Working Paper No. 27999, October 2020), https://www.nber.org/papers/w27999 ↩︎
290. Jean Guglielminotti, Ruth Landau, and Guohua Li, “The 2014 New York States Medicaid Expansion and Severe Maternal Morbidity,” Anesthesia and Analgesia 10 (January 2021), https://journals.lww.com/anesthesia-analgesia/Abstract/9900/The_2014_New_York_State_Medicaid_Expansion_and.64.aspx ↩︎
291. Janani Rajbhandari-Thappa, Donglang Zhang, Kara E. MacLeod, Kiran Thapa, “Impact of Medicaid Expansion on Insurance Coverage Rates Among Adult Populations with Low Income and by Obesity Status” The Obesity Society 28 no. 7 (April 2020): 1219-1223, https://doi.org/10.1002/oby.22793 ↩︎
292. Barbara H. Braffett, “Health Care Coverage and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes: Results From the TODAY2 Study,” Diabetes Care 43, no. 10 (October 2020): 2469-2477, https://doi.org/10.2337/dc20-0760 ↩︎
293. Hawazin W. Elani, Benjamin D. Sommers, and Ichiro Kawachi, “Changes In Coverage And Access To Dental Care Five Years After ACA Medicaid Expansion,” Health Affairs 39 no. 11 (November 2020): 1900-1908, https://doi.org/10.1377/hlthaff.2020.00386 ↩︎
294. Nosayaba Osazuwa-Peters et al., “State Medicaid Expansion Status, Insurance Coverage and Stage at Diagnosis in Head and Neck Cancer Patients,” Oral Oncology 110 (November 2020), https://doi.org/10.1016/j.oraloncology.2020.104870 ↩︎
295. Terceira Ann Berdahl and Asako Moriya, “Insurance Coverage for Non-standard Workers: Experiences of Temporary Workers, Freelancers, and Part-time Workers in the USA, 2010-2017,” Journal of General Internal Medicine Epub ahead of print (March 2021): 1-7, https://doi.org/10.1007/s11606-021-06700-0 ↩︎
296. Janani Rajbhandari-Thappa, Donglang Zhang, Kara E. MacLeod, Kiran Thapa, “Impact of Medicaid Expansion on Insurance Coverage Rates Among Adult Populations with Low Income and by Obesity Status” The Obesity Society 28 no. 7 (April 2020): 1219-1223, https://doi.org/10.1002/oby.22793 ↩︎
297. Matthew Buettgens, Fredric Blavin, and Clare Pan, “The Affordable Care Act Reduced Income Inequality In The US,” Health Affairs 40 no. 1(January 2021): 121-129, https://doi.org/10.1377/hlthaff.2019.00931 ↩︎
298. Anitha Menon, Payal K. Patel, Monita Karmakar, and Renuka Tipirneni, “The Impact of the Affordable Care Act Medicaid Expansion on Racial/Ethnic and Sex Disparities in HIV Testing: National Findings fromthe Behavioral Risk Factor Surveillance System,” Journal of General Internal Medicine Epub ahead of print (January 2021), https://doi.org/10.1007/s11606-021-06590-2 ↩︎
299. Bita Fayaz Farkhad, David R. Holtgrave, and Dolores Albarracín, “Effect of Medicaid Expansions on HIV Diagnoses and Pre-Exposure Prophylaxis Use,” American Journal of Preventive Medicine Epub ahead of print (January 2021), https://doi.org/10.1016/j.amepre.2020.10.021 ↩︎
300. George Pro et al., “The Role of State Medicaid Expansions in Integrating Comprehensive Mental Health Services into Opioid Treatment Programs: Differences Across the Rural/Urban Continuum,” Community Mental Health Journal Epub ahead of print (October 2020), https://doi.org/10.1007/s10597-020-00719-z ↩︎
301. Matthew Dalstrom, Laurence G. Weinzimmer, Roopa Foulger, and Colleen J. Klein, “Medicaid Expansion and Accessibility to Healthcare: The Illinois Experience,” Public Health Nursing Epub ahead of print (March 2021), https://doi.org/10.1111/phn.12899 ↩︎
302. Amie Goodin, Jeffery Talbert, Patricia R. Freeman, Ellen J. Hahn, and Amanda Fallin-Bennett, “Appalachian Disparities in Tobacco Cessation Treatment Utilization in Medicaid,” Substance Abuse Treatment, Prevention, and Policy 15, no. 5 (January 2020), https://doi.org/10.1186/s13011-020-0251-0 ↩︎
303. Kevin Callison, Brigham Walker, Charles Stoecker, Jeral Self, and Mark L. Diana, “Medicaid Expansion Reduced Uncompensated Care Costs At Louisiana Hospitals; May Be A Model For Other States,” Health Affairs 40 no. 3 (March 2020): 529-535, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2020.01677?journalCode=hlthaff ↩︎
304. Ali Moghtaderi, Jesse Pines, Mark Zocchi, and Bernard Black, “The Effect of Affordable Care Act Medicaid Expansion on Hospital Revenue,” Health Economics 29 no. 12 (December 2020): 1682-1704, https://doi.org/10.1002/hec.4157 ↩︎
305. Fredric Blavin and Christal Ramos, “Medicaid Expansion: Effects On Hospital Finances And Implications For Hospitals Facing COVID-19 Challenges,” Health Affairs 40 no. 1 (January 2021): 82-90, https://doi.org/10.1377/hlthaff.2020.00502 ↩︎
306. Tyler L. Malone, George H. Pink, George M. Holmes, “Decline in Inpatient Volume at Rural Hospitals,” The Journal of Rural Health Epub ahead of print (December 2020), https://onlinelibrary.wiley.com/doi/10.1111/jrh.12553 ↩︎
307. Genevieve P. Kanter, Bardia Nabet, Meredith Matone, and David M. Rubin, “Association of State Medicaid Expansion With Hospital Community Benefit Spending,” Jama Network Open 3 no. 5 (May 2020), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766544 ↩︎
308. Charles Liu, Yusuke Tsugawa, and Thomas J Weiser, “Association of the US Affordable Care Act With Out-of-Pocket Spending and Catastrophic Health Expenditures Among Adult Patients With Traumatic Injury,” Jama Network Open 3 no.2 (February 2020): 1-12, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2762020 ↩︎
309. Hiroshi Gotanda, Ashish K Jha, Gerald F Kominski, and Yusuke Tsugawa, “Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study,” BMJ 368 (February 2020), https://doi.org/10.1136/bmj.m40 ↩︎
310. Matthew Buettgens, Fredric Blavin, and Clare Pan, “The Affordable Care Act Reduced Income Inequality In The US,” Health Affairs 40 no. 1(January 2021): 121-129, https://doi.org/10.1377/hlthaff.2019.00931 ↩︎
311. Michael W. Sances and Andrea Louise Campbell, “State Policy and Mental Health Outcomes under COVID-19” Journal of Health Politics, Policy, and Law Epub ahead of print (March 2021), https://doi.org/10.1215/0361678-9155991 ↩︎
312. Purvi Sevak and Jodi Schimmel Hyde, “The ACA Medicaid Expansions and Employment of Adults With Disabilities,” Journal of Disability Policy Studies Epub ahead of print (July 2020), https://doi.org/10.1177/1044207320943554 ↩︎
313. Bradley Heim, Ithai Lurie, Kathleen J.Mullen, and Kosali Simon, “How Much Do Outside Options Matter? The Effect of Subsidized Health Insurance on Social Security Disability Insurance Benefit Receipt,” Journal of Health Economics 76 Epub ahead of print (January 2021), https://doi.org/10.1016/j.jhealeco.2021.102437 ↩︎
314. Ryan Yeung, “The Effect of the Medicaid Expansion on Dropout Rates,” Journal of School Health 90 no. 10 (August 2020): 745-753, https://onlinelibrary.wiley.com/doi/10.1111/josh.12937 ↩︎
315. Tyler N. A. Winkelman et al., “Medications for Opioid Use Disorder among Pregnant Women Referred by Criminal Justice Agencies before and after Medicaid Expansion: A Retrospective Study of Admissions to Treatment Centers in the United States,” PLOS Medicine 17 no. 5 (May 2020), https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003119 ↩︎
316. Carrie E. Fry, Thomas G. McGuire, and Richard G. Frank, “Medicaid Expansion’s Spillover to the Criminal Justice System: Evidence from Six Urban Counties,” RSF: The Russell Sage Foundation Journal of the Social Sciences 6 no. 2 (July 2020): 244-263, https://www.jstor.org/stable/10.7758/rsf.2020.6.2.11 ↩︎
317. Jeral Self, Kevin Callison, Anthony Goudie, Kanna Lewis, and Joseph Thompson, “Medicaid Expansion And Health Services Use For Adults Experiencing Homelessness In Arkansas,” Health Affairs 40 no. 1 (January 2021): 91-97, https://doi.org/10.1377/hlthaff.2019.01812 ↩︎

The KFF COVID-19 Vaccine Monitor is an ongoing research project tracking the public’s attitudes and experiences with COVID-19 vaccinations. Using a combination of surveys and qualitative research, this project tracks the dynamic nature of public opinion as vaccine development and distribution unfold, including vaccine confidence and acceptance, information needs, trusted messengers and messages, as well as the public’s experiences with vaccination.

Key Findings

• With eligibility for COVID-19 vaccination now open to all adults in the U.S., the latest KFF COVID-19 Vaccine Monitor shows that while the pace of vaccine uptake has continued rapidly over the past month, enthusiasm may be reaching a plateau. The share of adults who say they’ve gotten at least one dose of a vaccine or intend to do so as soon as possible inched up from 61% in March to 64% in April, while the share who want to “wait and see” before getting vaccinated – a group that had been steadily decreasing in size since over several months – remained about the same in April (15%) compared to March (17%). Among Republicans, a group that has been slower to embrace the vaccine, over half now say they’ve gotten at least one dose or will do so as soon as they can. The share of Republicans who say they will “definitely not” get vaccinated decreased from 29% in March to 20% in April but remains substantially larger than the share among Democrats or independents.
• In the wake of news about blood clots possibly linked to the Johnson & Johnson COVID-19 vaccine and the subsequent pause in the use of this vaccine, less than half the public expresses confidence in the safety of the Johnson & Johnson vaccine, and concerns about potential side effects have increased among those not yet vaccinated, especially women. Hispanic women are particularly likely to say that the news of these blood clots caused them to rethink their vaccination decision. Despite this, the trajectory of vaccine uptake and enthusiasm does not appear to have slowed disproportionately among women over the past month. Two-thirds (66%) of women say they’ve been vaccinated or will do so as soon as possible, compared to 63% of men.
• Among those who are open to getting vaccinated but have not yet tried to get an appointment, reasons range from safety concerns to logistical barriers to questions about eligibility, and vary widely by vaccination intention. Those who say they want the vaccine as soon as possible mainly cite logistical concerns and information needs; those in the wait and see group mainly express safety concerns or a lack of research, and those who say they’ll get the vaccine only if required mainly say they don’t feel they want or need the vaccine. By contrast, when those who say they will “definitely not” get vaccinated are asked if there is anything that might change their mind, the answer is a resounding “no.”
• While side effects and safety top the list of concerns for those who haven’t gotten vaccinated for COVID-19, we continue to find that lack of information and access are barriers for some individuals, particularly people of color. For example, Black and Hispanic adults are more likely than White adults to be concerned about having to miss work due to side effects, having to pay out-of-pocket for the COVID-19 vaccine (even though it is free), or not being able to get the vaccine from a place they trust. In addition, 45% of Hispanic adults say they don’t have enough information about when they can get vaccinated and a similar share are not sure whether they are currently eligible to receive the vaccine in their state (even though eligibility is now open to all U.S. residents).
• About half of young adults ages 18-29 say they’ve already gotten at least one dose of a COVID-19 vaccine or will do so as soon as possible, but about a quarter say they still want to “wait and see” how the vaccine is working, higher than any other age group. Peer networks may play a role in encouraging vaccine uptake among young adults; those who say at least half of their close friends are vaccinated are much more enthusiastic about getting vaccinated themselves compared to those who say just a few or none of their friends have gotten a shot. In addition, young adults may be more receptive than older adults to vaccination requirements in order to travel or attend large gatherings.
• As the U.S. awaits authorization of a COVID-19 vaccine for use in children under age 16, three in ten parents of children ages 12-15 say they will get their child vaccinated as soon as a vaccine is available, one quarter say they will wait a while to see how the vaccine is working, 18% plan to get their child vaccinated if their school requires it, and nearly a quarter say they will definitely not get their child vaccinated. Perhaps unsurprisingly, parents’ intentions for vaccinating their kids largely line up with their own intentions for getting the COVID-19 vaccine themselves.

Trends In COVID-19 Vaccination Intentions

With eligibility for COVID-19 vaccination now open to all adults in the U.S., the latest KFF COVID-19 Vaccine Monitor reports that a majority of adults now say they have already gotten at least one dose of the vaccine (56%), up from 32% in March. At the same time, the share of ready and willing adults who have not yet gotten vaccinated but say they intend to do so as soon as they can has fallen to 9% from 30% in March when many adults were still not eligible for vaccination. Overall, the total enthusiastic group (those who say they’ve already been vaccinated or will get it as soon as possible) inched up only slightly from 61% in March to 64% in April, while the share of adults who say they want to “wait and see” appears to have plateaued at 15%, similar to the 17% who said the same in March. The shares of the public who say they will get the vaccine only if they are required to do so for work, school, or other activities (6%) or say they will “definitely not” get the vaccine (13%) have stayed about the same since January.

Enthusiasm for getting the COVID-19 vaccine has continued to inch upward across racial and ethnic groups, but at a slower pace than in previous months. About six in ten Black (59%) adults and two-thirds of Hispanic (64%) and White (66%) adults now say they’ve either gotten at least one dose of the vaccine or will get it as soon as they can. At the same time, Black and Hispanic adults remain somewhat more likely than White adults to say they want to “wait and see” before getting vaccinated (19%, 18%, and 13%, respectively).

Among older adults, similar shares across racial and ethnic groups say that they have received at least one dose of a COVID-19 vaccine (roughly eight in ten among ages 65 and over and roughly six in ten among ages 50-64). However, among younger adults (those under age 50), a larger share of White adults (50%) compared to Black and Hispanic adults (36% each) say they’ve already gotten vaccinated. Fewer White adults under the age of 50 say they will “wait and see” (16% compared to 24% of both Black and Hispanic adults in this age range).

Among partisans, enthusiasm for getting the COVID-19 vaccine remains highest among Democrats but may have reached a plateau among this group. Eight in ten Democrats say they’ve already gotten at least one dose of the vaccine or will get it as soon as possible, virtually unchanged from the share who said so last month (79%). Increasing enthusiasm among independents may also be slowing down, with six in ten (59%) now saying they’ve gotten at least one dose r will do so as soon as they can, similar to the 57% who said so in March.

While the growth in vaccine enthusiasm appears to have slowed among independents and Democrats, it has continued to increase among Republicans, with a majority (55%) now saying they have either received at least one dose of the vaccine or intend to do so as soon as possible. One in five Republicans (20%) say they will “definitely not” get vaccinated, down from 29% last month but still substantially larger than the share among independents (13% and Democrats (4%).

Across key demographic groups, at least half of adults say they have already gotten at least one dose of the vaccine or will get it as soon as it is available to them. Older adults, Democrats, and college graduates remain the most enthusiastic about getting the vaccine, with at least seven in ten indicating they’ve gotten at least one shot. Roughly one-quarter (24%) of young adults ages 18-29 say they still want to “wait and see” before getting vaccinated, as do about one in five Black adults (19%), adults without a college degree (19%), political independents (19%), urban residents (19%), and Hispanic adults (18%).

Among older adults, similar shares across racial and ethnic groups say that they have received at least one dose of a COVID-19 vaccine (roughly eight in ten among ages 65 and over and roughly six in ten among ages 50-64). However, among younger adults (those under age 50), a larger share of White adults (50%) compared to Black and Hispanic adults (36% each) say they’ve already gotten vaccinated. Fewer White adults under the age of 50 say they will “wait and see” (16% compared to 24% of both Black and Hispanic adults in this age range).

Notably, about one in five Hispanic adults ages 18-49 (18%) and ages 50-64 (20%) say they have not yet been vaccinated but intend to do so as soon as possible, suggesting a possible barrier to access for these groups.

Confidence and Concerns Following Johnson & Johnson Vaccine Safety Review

On April 13^th, the U.S. Food and Drug Administration (FDA) and the U.S. Centers for Disease Control (CDC) recommended a temporary pause on the use of Johnson & Johnson’s Covid-19 vaccine following reports of rare blood clots. Ten days later, after both agencies conducted a safety review, the FDA and CDC recommended that the use of the Johnson & Johnson vaccine should resume. The latest KFF COVID-19 Vaccine Monitor (which was fielded just after the pause began and remained in the field after the pause was lifted) finds that while overall confidence in safety of the COVID-19 vaccines currently available in the U.S. is high, less than half say they are at least somewhat confident the Johnson & Johnson vaccine is safe (46%), compared to nearly seven in ten who say the same about the Moderna and Pfizer vaccines (69% each)¹ . Fifteen percent say they are “very confident” that the Johnson & Johnson vaccine is safe, less than half the share who say the same about the Moderna and Pfizer vaccines, or the COVID-19 vaccines overall.

Confidence in the COVID-19 vaccines overall – and in each of the specific vaccines – is lower among those who have not yet been vaccinated than it is among those who have already received the vaccine and varies by vaccination intention. Among those who want to “wait and see” before getting the vaccine, slight majorities say they are confident that the Pfizer vaccine (55%) and Moderna vaccine (53%) are safe, compared to 28% who say the same of the Johnson & Johnson vaccine. There is less variation in confidence levels across the different vaccines among those in the “only if required” group, while those who say they will “definitely not” get vaccinated express very little confidence in the safety of any of the COVID-19 vaccines.

Most adults (78%) say they have heard or read at least a little about some rare cases in which a small number of individuals developed blood clots within two weeks of getting the Johnson & Johnson COVID-19 vaccine. Among those who have not yet been vaccinated, the large majority either say the news “has not changed their mind about getting vaccinated” (56%) or say they have “not heard or read anything at all” about these cases (21%). However, about one in five unvaccinated adults say the news caused them to change their mind about getting a COVID-19 vaccine, including 9% who say it made them less likely to want the Johnson & Johnson vaccine but didn’t change their minds about the other vaccines, 7% who say it made them less likely to want any COVID-19 vaccine, and 4% who say it changed their thoughts about the vaccines in some other way.

Most of the blood clot cases reported occurred among women, and we find a larger share of unvaccinated women (83%) than unvaccinated men (73%) say they have heard or read at least a little about this news. In addition, unvaccinated women are less likely than unvaccinated men to say they are confident in the safety of the Johnson & Johnson vaccine (21% vs. 32%), though there is no significant gender difference in confidence of the safety of COVID-19 vaccines overall.

Notably, 39% of unvaccinated Hispanic women say they heard the news and it caused them to change their mind about the vaccine, including 15% who say it made them less likely to want the Johnson & Johnson vaccine and 18% who say it made them less likely to want any COVID-19 vaccine.

The Monitor also finds indications that concerns about side effects from the vaccines overall have increased in the wake of the Johnson & Johnson pause, particularly among women. Among those who are not yet convinced to get the vaccine right away (those who want to wait and see, will get vaccinated only if required, or will definitely not get vaccinated), 81% say they are concerned they might experience serious side effects from the vaccine, up from 70% last month. Among women within this group, concern increased by 15 percentage points, from 77% in March to 92% in April.

Despite what appear to be heightened concerns about safety and side effects among women, the trajectory of vaccine uptake and enthusiasm does not appear to have slowed significantly among women over the past month. Two-thirds (66%) of women say they’ve been vaccinated or will do so as soon as possible, compared to 61% in March. Among men, 63% now say they’ve gotten vaccinated or are eager to do so, compared to 62% in March.

In addition, despite these concerns about the Johnson & Johnson vaccine, a one-dose vaccine still has an appeal for many people. Three in ten unvaccinated adults (29%), including 45% of those in the “wait and see” category say they would be more likely to get the vaccine if they only needed one dose.

What Is Keeping People From Getting Vaccinated?

Most unvaccinated adults, including a majority of those who say they will get the vaccine as soon as they can, have not yet attempted to make an appointment for a vaccine, despite all adults in the U.S. now being eligible. Twelve percent of those who have not received a COVID-19 vaccine say they have tried to make an appointment to get vaccinated, including 38% of those who say they want the vaccine as soon as possible, 8% of those in the “wait and see” group, and 6% of those who say they’ll get the vaccine only if required. Majorities across all these groups say they have not yet tried to make an appointment.

When those who indicate some willingness to get vaccinated (saying they’ll get the vaccine as soon as they can, will wait and see, or will get it if required) are asked to say in their own words the main reason why they have not tried to get an appointment, reasons range from safety concerns to logistical barriers to questions about eligibility, and vary widely by vaccination intention.

Among the group that says they want the vaccine as soon as possible, logistical concerns and information needs top the list of reasons for not making an appointment, including being too busy or not having time to try to get an appointment (14%) and not being able to take the time off work (12%). Another 9% of this group say they just haven’t gotten around to it, 8% say they are not sure about their eligibility or whether they have the right documentation, and 7% express a general lack of information about how to get vaccinated.

Among those who want to wait and see before getting vaccinated, one-fourth (23%) say they haven’t tried to get an appointment yet because they are waiting until more people have gotten the vaccine. Others in this group say they are concerned about the safety or side effects of the vaccine (14%) or that the vaccine is too new or there is not enough research available (9%), while 8% say they just generally don’t want or need the vaccine.

Among those who say they’ll get the vaccine only if required, the largest share says they haven’t made an appointment because they don’t want or need the vaccine (26%), while one in ten cite concerns about safety or side effects and 6% feel the vaccine is too new or hasn’t been researched enough.

In contrast to the range of barriers and concerns cited by those who are at least somewhat open to getting vaccinated, when those who say they will “definitely not” get a COVID-19 vaccine are asked if there is anything that might convince them to change their mind, the answer is overwhelmingly “no,” with 72% providing this response. Seven percent of this group say that more research on the vaccines might convince them to change their minds, while the remainder gave a range of other response.

Other Concerns And Barriers To Vaccination

While vaccine side effects and safety continue to be the top concerns among those who have not yet been vaccinated (cited as concerns by 76% and 70%, respectively), there are a range of other concerns that vary by vaccination intention. For example, six in ten (59%) of those not yet vaccinated (rising to 72% of the “definitely not” group) are concerned that they might be required to get the COVID-19 vaccine even if they don’t want to. About half (48%) of those ages 18-49 (rising to 66% among the “definitely nots”) are concerned that the COVID-19 vaccine might negatively impact their fertility in the future. Many express work-related concerns, including half (48%)  who say they are concerned they might miss work if the vaccine side effects make them feel sick and one in five who say they are concerned they may need to time off work to go and get the vaccine. One-third (32%) are concerned that they might have to pay an out-of-pocket cost to get vaccinated, even though the vaccine is available for free to all U.S. adults. Other concerns include being required to provide a social security number or government-issued identification to get vaccinated (34%), not being able to get the vaccine from a trusted place (32%), or that it will be difficult to  travel to a vaccination site (15%).

Many concerns about COVID-19 vaccination are expressed at higher rates by people of color compared to White adults. For example, nearly six in ten Hispanic adults (58%) under age 50 say they are concerned that the vaccine may negatively impact their future fertility, compared to 42% of White adults in this age range. In addition, potential access-related barriers to vaccination are more commonly expressed as concerns by Black and Hispanic adults compared to White adults. More than half (55%) of unvaccinated Black adults and almost three-quarters (64%) of Hispanic adults are concerned about having to miss work due to vaccine side effects compared to four in ten White adults (41%). Larger shares of Black and Hispanic adults compared to White adults also express concern about not being able to get the vaccine from a place they trust, having to pay an out-of-pocket cost to get vaccinated, and having difficulty traveling to a vaccination site.

In addition to these concerns, lack of information is still a barrier to getting a COVID-19 vaccine for many adults, particularly people of color. Three in ten unvaccinated adults overall, rising to 42% of Hispanic adults, say they are not sure whether they’re currently eligible to get a vaccine in their state, even though eligibility is now open to all U.S. adults. In addition, one in five unvaccinated adults overall (29% of Hispanic adults) say they don’t have enough information about where to get a COVID-19 vaccine and 26% (45% of Hispanic adults) say they don’t have enough information about when they can get one.

Incentives And Requirements That Might Increase Vaccination Uptake

In addition to understanding and addressing people’s concerns about the vaccines, there are various incentives, conveniences, and requirements that may be effective at encouraging some people to get vaccinated. Three in ten unvaccinated adults who are not yet ready to get the vaccine right away, including nearly half of those who want to “wait and see,” say they would be more likely to get the vaccine if it was offered to them at a place they normally go for health care or if they only needed to get one dose. At least a quarter of those who are not yet ready to get the vaccine right away, including substantial shares of those in both the “wait and see” and “only if required” groups say they would be more likely to get vaccinated if it was required to fly on an airplane, to attend large gatherings such as sporting events or concerns, or for international travel.

Employer policies and incentives could also play a role in increasing COVID-19 vaccination uptake. About three in ten (28%) of employed adults who are not yet ready to get vaccinated, including nearly half (47%) in the “wait and see” group, say they would be more likely to get vaccinated if their employer gave them paid time off to get vaccinated and recover from any side effects. About a quarter overall and four in ten (39%) in the “wait and see” group say they would be more likely to get vaccinated if their employer offered a financial incentive of $200, while two in ten overall and about a third (32%) of those who want to “wait and see” say they would be more likely to get the vaccine if their employer arranged for a  medical provider to administer it at their workplace.

Vaccine Misinformation

The latest KFF Vaccine Monitor also finds that a majority of adults (54%) either believe some common misinformation about the COVID-19 vaccines or are unsure whether these things are true or false. About one in four believe or are unsure whether you can get COVID-19 from the vaccine and one in five believe or are unsure whether those who have already had COVID-19 should not get vaccinated, whether the vaccines contain fetal cells, have been shown to cause infertility, or that the vaccine can change your DNA. Among younger adults ages 18 to 29, four in ten (42%) say they have heard that the COVID-19 has been shown to cause infertility, and about one in four either are unsure if that is true (22%) or believe that is true (5%).

Belief in or uncertainty towards vaccine misinformation is highest among those most reluctant to get the vaccine. Eight in ten (81%) of adults who say they will “definitely not” get the vaccine believe or are unsure about at least one common COVID-19 vaccine myth, as do 75% of those who say they will only get the vaccine if required. In addition, vaccine misinformation appears to be wide-reaching, as even among those who have already been vaccinated 43% believe or are uncertain about at least one common vaccine myth, as do half of those who say they want the vaccine as soon as possible.

A larger share of women (58%) than men (50%) believe or be unsure about at least one common myth surrounding the COVID-19 vaccine. Likewise, younger adults are more likely than those 65 and older to believe or be unsure about a vaccine myth. Across partisans, majorities of Republicans (58%) and independents (56%) believe or are unsure about at least one vaccine myth, compared to a smaller share of Democrats (43%).

Young Adults and Vaccine Uptake

Though they are at lower risk of complications from COVID-19, many experts believe vaccine uptake among young adults will be needed in order to achieve herd immunity. Young adults ages 18 to 29 are the least likely to say they’ve already been vaccinated or intend to do so as soon as possible, and about one-quarter (24%) say they want to “wait and see” before they get the COVID-19 vaccine. In addition, half of younger adults say “just a few” or “none” of their close friends have been vaccinated, including one in five 18-29 year-olds who say none of their close friends are vaccinated and a further 31% say only a few of their friends have gotten the vaccine.

For young adults, peer influences may have a big effect on vaccination decisions. Among young adults ages 18-29, a large majority (77%) of those who say at least half of their close friends have been vaccinated report having already received at least one dose of a COVID-19 vaccine themselves (68%) or say they want to as soon as they can (9%). Among those who say just a few or none of their friends have been vaccinated, a much smaller share say they’ve already been vaccinated or intend to do so as soon as possible (32%), while three in ten (29%) say they will “wait and see,” one in five (19%) say they will get vaccinated only if required, and 17% say they will “definitely not” get the vaccine.

Compared to those in other age groups, young adults may be particularly motivated by requirements and conveniences to encourage COVID-19 vaccine uptake. About four in ten young adults ages 18 to 29 who are not yet ready to get the vaccine right away say they would be more likely to get vaccinated if it was offered at a place they normally go for health care (43%) or if they only needed to get one dose of the vaccine (37%). Among requirements, about four in ten young adults in this group say they would be more likely to get vaccinated if it was required to fly on an airplane (40%), to attend large gatherings (39%), or for international travel (38%).

COVID-19 Vaccinations for Children

While the Pfizer COVID-19 vaccine is already authorized for use in children ages 16-17, there is currently no vaccine available in the U.S. for children ages 15 and under. Earlier this month, Pfizer requested that the FDA extend their emergency use authorization for their COVID-19 vaccine for use in children between the ages of 12 and 15 following promising clinical trials, and FDA authorization is expected as soon as next week. Over the last month, Pfizer and Moderna have started testing their COVID-19 vaccines in children between the ages of 6 months and 12 years old.

Around three in 10 (29%) parents of children under age 18 say they’ll get their child vaccinated “right away” once a COVID-19 vaccine is authorized and available for their child’s age group. An additional one third (32%) say they’ll wait awhile to see how the vaccine is working before getting their child vaccinated. One-third say they will only get their child vaccinated if their school requires it (15%) or they definitely won’t get their child vaccinated (19%).

Among parents who have at least one child between the ages of 12-15, responses are similar: 30% say they’ll get their child vaccinated right away, 26% will wait to see how it’s working, 18% will vaccinate only if their child’s school requires it, and 23% say they will definitely not get their child vaccinated. Among parents who have at least one child ages 16-17 (for whom the Pfizer vaccine is already approved), thirty-one percent report wanting to get them vaccinated right away and another 8 percent say their child is already vaccinated, while almost quarter say they will definitely not get them vaccinated.

Across racial and ethnic groups, at least half of parents say they will get their child vaccinated for COVID-19 as soon as a vaccine is authorized for children (25% of Black parents, 31% of Hispanic parents, 30% of White parents) or that they will wait a while to see how it is working (25% of Black parents, 36% of Hispanic parents, 31% of White parents). A smaller share of Hispanic parents (10%) compared to Black parents (29%) and White parents (22%) say they will “definitely not” get their child vaccinated.

Parents’ intentions for vaccinating their children against COVID-19 largely line up with their own vaccination experiences and intentions. Among parents who have already received at least one dose of the vaccine or want it as soon as possible, three-fourths say they will either get their children vaccinated right away (48%) or will wait a while to see how it’s working (29%). Among parents who are still in “wait and see” mode when it comes to their own vaccination, 63% say they will also wait and see before getting their child vaccinated. Similarly, about six in ten (58%) of parents who say they will definitely not get vaccinated for COVID-19 themselves or will do so only if required say they will definitely not vaccinate their children.

This KFF COVID-19 Vaccine Monitor was designed and analyzed by public opinion researchers at the Kaiser Family Foundation (KFF). The survey was conducted April 15-29, 2021, among a nationally representative random digit dial telephone sample of 2,097 adults ages 18 and older (including interviews from 778 Hispanic adults and 507 non-Hispanic Black adults), living in the United States, including Alaska and Hawaii (note: persons without a telephone could not be included in the random selection process). Phone numbers used for this study were randomly generated from cell phone and landline sampling frames, with an overlapping frame design, and disproportionate stratification aimed at reaching Hispanic and non-Hispanic Black respondents. Stratification was based on incidence of the race/ethnicity subgroups within each frame. Specifically, the cell phone frame was stratified as: (1) High Hispanic: Cell phone numbers associated with rate centers from counties where at least 35% of the population is Hispanic; (2) High Black: Cell phone numbers associated with remaining rate centers from counties where at least 35% of the population is non-Hispanic Black; (3) Else: numbers from all remaining rate centers. The landline frame was stratified as: (1) High Black: landline exchanges associated with Census block groups where at least 35% of the population is Black; (2) Else: all -remaining landline exchanges. The sample also included 163 respondents reached by calling back respondents that had previously completed an interview on the KFF Tracking poll at least nine months ago. Another 358 interviews were completed with respondents who had previously completed an interview on the SSRS Omnibus poll (and other RDD polls) and identified as Hispanic (n = 221; including 67 in Spanish and 40 who screened as potentially undocumented) or non-Hispanic Black (n=137). An oversample of potentially undocumented Hispanic (n=32) respondents was reached by dialing prepaid cell phone number in the High Hispanic stratum and screening for potential residency status. Computer-assisted telephone interviews conducted by landline (298) and cell phone (1,799, including 1,411 who had no landline telephone) were carried out in English and Spanish by SSRS of Glen Mills, PA. To efficiently obtain a sample of lower-income and non-White respondents, the sample also included an oversample of prepaid (pay-as-you-go) telephone numbers (25% of the cell phone sample consisted of prepaid numbers) Both the random digit dial landline and cell phone samples were provided by Marketing Systems Group (MSG). For the landline sample, respondents were selected by asking for the youngest adult male or female currently at home based on a random rotation. If no one of that gender was available, interviewers asked to speak with the youngest adult of the opposite gender. For the cell phone sample, interviews were conducted with the adult who answered the phone. KFF paid for all costs associated with the survey.

The combined landline and cell phone sample was weighted to balance the sample demographics to match estimates for the national population using data from the Census Bureau’s 2019 U.S. American Community Survey (ACS), on sex, age, education, race, Hispanic origin, and region, within race-groups, along with data from the 2010 Census on population density. The sample was also weighted to match current patterns of telephone use using data from the January- June 2020 National Health Interview Survey The weight takes into account the fact that respondents with both a landline and cell phone have a higher probability of selection in the combined sample and also adjusts for the household size for the landline sample, and design modifications, namely, the oversampling of potentially undocumented respondents and of prepaid cell phone numbers, as well as the likelihood of non-response for the re-contacted sample. All statistical tests of significance account for the effect of weighting.

The margin of sampling error including the design effect for the full sample is plus or minus 3 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available by request. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll. Kaiser Family Foundation public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.

This work was supported in part by grants from the Chan Zuckerberg Initiative DAF (an advised fund of Silicon Valley Community Foundation), the Ford Foundation, and the Molina Family Foundation. We value our funders. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.

1. After the field work was completed, the researchers analyzed whether attitudes towards the safety of the Johnson & Johnson vaccine changed during the field period, notably after the pause was lifted. No significant differences on this measure were noted. ↩︎