The Effects of Medicaid Expansion under the ACA: Studies from January 2014 to January 2020

Authors: Madeline Guth, Rachel Garfield, and Robin Rudowitz
Published: Mar 17, 2020

Executive Summary

Another analysis that reviews studies published between February 2020 and March 2021 is available here. That more recent analysis also updates summary figures on coverage, access, and economic findings across the full body of research published between January 2014 and March 2021.

At the ten year mark since the passage of the Affordable Care Act (ACA), a substantial body of research has investigated effects of the Medicaid expansion on coverage; access to care and related measures (including utilization, quality of care and health outcomes, provider capacity, and affordability and financial security); and various economic measures. This issue brief summarizes findings from 404 studies (including 80 newly included since the last update of this analysis) of the impact of state Medicaid expansions under the ACA published beginning in January 2014 (when the coverage provisions of the ACA went into effect) and updates earlier versions of this brief with studies through January 2020.1 

This brief groups outcomes into three broad categories: coverage, access, and economic measures. Research indicates that the 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 (Figure 1).

Figure 1: Studies generally find positive effects of the ACA Medicaid expansion on different outcomes.

Studies included in this review may include multiple findings across multiple categories. For example, studies that point to increased coverage may also include findings related to access, outcomes, or economic metrics. 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 (Figure 2).

Figure 2: More recent studies focus on outcomes related to access.

Findings related to coverage, access, and economic measures are discussed in detail in the text of this brief and are also summarized below:

Coverage: Studies show that Medicaid expansion states experienced significant coverage gains and reductions in uninsured rates among the low-income population broadly and within specific vulnerable populations. States that implemented the expansion with a waiver have seen coverage gains, but some waiver provisions appear to compromise coverage.

Access to care and related measures: Most research demonstrates that Medicaid expansion has improved access to care, utilization of services, the affordability of care, and financial security among the low-income population. Studies show improved self-reported health following expansion and an association between expansion and certain positive health outcomes. A small subset of study findings showed no effects of expansion on certain specific measures within these access-related categories. Findings on expansion’s effect on provider capacity are mixed, with studies showing increases, decreases, or no effects on measures like appointment availability or wait times.

Economic measures: Analyses find effects of expansion on numerous economic outcomes, including state budget savings, revenue gains, and overall economic growth. Multiple studies suggest that expansion can result in state savings by offsetting state costs in other areas. The federal government covered 100% of the cost of the expansion in the early years of the ACA and will cover 90% beginning in 2020. There is limited research examining the fiscal effects of the Medicaid expansion at the federal level. Additional studies show that Medicaid expansions result in reductions in uncompensated care costs for hospitals and clinics, and a growing number of studies show an association between expansion and gains in employment as well as growth in the labor market (with a minority of studies showing neutral effects in this area).

More recent studies: Recently published studies newly included in this analysis from July 2019 through January 2020 support earlier findings while using the additional years of experience with expansion to deepen findings in many areas, including expansion’s effects on health outcomes, access to services and medications for behavioral health and other needs, providers’ financial stability, and employment. Some recent analyses that include outcomes beyond those typically examined in Medicaid expansion research show that expansion is associated with decreased mortality overall and for certain specific conditions; reductions in rates of food insecurity, poverty, and home evictions; and improvements in measures of self-reported health and healthy behaviors.

Looking back and looking ahead: Looking back on 10 years since the ACA has been enacted shows that the Medicaid expansion has expanded coverage and led to increases in access and utilization to health care services, improvements in financial security and positive net effects for state budgets and revenues. This analysis may help inform states still debating whether to adopt the expansion. Future studies will continue to examine the economic implications of the expansion as the state share of costs remains constant at 10 percent. A looming economic downturn will also test how the Medicaid expansion affects coverage and state budgets. Looking ahead, while additional states may expand eligibility under the ACA, the changing landscape of Medicaid demonstration activity could limit the reach of the Medicaid expansion as envisioned under the law. For example, the administration issued new guidance that would allow states to cover certain adults (including the expansion population) through new demonstrations with eligibility restrictions and not apply other Medicaid rules in exchange for capped financing. In addition, continued efforts from the administration to conduct intense oversight and change the rules on Medicaid enrollment and financing, as well as litigation efforts to repeal the entire ACA keep the law in the spotlight and highlight future challenges. The outcome of the next election could bring significant changes to the ACA, including the Medicaid expansion.

Methods

This literature review summarizes findings from 404 studies of the impact of state Medicaid expansions under the ACA published beginning in January 2014 (when the coverage provisions of the ACA went into effect). This version of the brief updates earlier versions and includes studies published through January 2020. It includes studies, analyses, and reports published by government, research, and policy organizations using data from 2014 or later and only includes studies that examine impacts of the Medicaid expansion in expansion states. This review excludes studies on impacts of ACA coverage expansions generally (not specific to Medicaid expansion alone), studies investigating potential effects of expansion in states that have not (or had not, at the time of the study) expanded Medicaid, and reports from advocacy organizations and media sources.

To collect relevant studies, we conducted keyword searches of PubMed and other academic health/social policy search engines as well as websites of government, research, and policy organizations that publish health policy-related research. We also used a snowballing technique of pulling additional studies from reference lists in previously pulled papers. While we tried to be as comprehensive as possible in our inclusion of studies and findings that meet our criteria, it is possible that we missed some relevant studies or findings. For each study, we read the final paper/report and summarized the population studied, data and methods used, and findings. In instances of conflicting findings within a study, or if a reviewer had questions about specific findings, multiple reviewers read and classified the study to characterize its findings. In the issue brief text, findings are broken out and reported separately in three broad categories: Medicaid expansion’s impact on coverage; access to care and related measures; and economic outcomes for the expansion states. Studies may be cited in multiple of these categories or in multiple places within a category. The Appendix at the end of the brief provides a list of citations for each of the included studies, grouped by the three categories of findings.

Report

Impacts on Coverage

Studies find positive effects of Medicaid expansion on a range of outcomes related to insurance coverage (Figure 3). In addition to changes in uninsured rates and Medicaid coverage, both overall and for specific populations, studies also consider private coverage and waiver implications.

Figure 3: Studies find that the ACA Medicaid expansion had positive effects on insurance coverage, though findings on private coverage are mixed.

Uninsured Rate and Medicaid Coverage Changes

States expanding their Medicaid programs under the ACA have seen large increases in Medicaid enrollment. These broad coverage increases have been driven by enrollment of adults made newly eligible for Medicaid under expansion. Enrollment growth also occurred among both adults and children who were previously eligible for but not enrolled in Medicaid (known as the “woodwork” or “welcome mat” effect). Some, but not all, research finds evidence of reduced coverage churn in expansion compared to non-expansion states.2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59  60  61 

Numerous analyses demonstrate that Medicaid expansion states experienced large reductions in uninsured rates that significantly exceed those in non-expansion states. The sharp declines in uninsured rates among the low-income population in expansion states are widely attributed to gains in Medicaid coverage. Declines began in 2014, and some studies showed that expansion-related enrollment growth in Medicaid and declines in uninsured rates in expansion states continued in 2015, 2016, and 2017 and that the gap between coverage rates in expansion and non-expansion states continued to widen in the years after 2014. Two studies found that despite a nationwide increase in uninsured rates from 2016 to 2017, uninsured rates remained stable in states that had expanded Medicaid and coverage losses were concentrated in non-expansion states.62  63  64  65  66  67  68  69  70  71  72  73  74  75  76  77  78  79  80  81  82  83  84  85  86  87  88  89  90  91  92  93  94  95  96  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  124  125  126  127  128  129  130  131  132  133  134  135  136  137  138 

Several studies identified larger coverage gains in expansion versus non-expansion states for specific vulnerable populations. While the list of specific populations studied is long, studies include: individuals across the lifespan (children, young adults, women of reproductive age with and without children, and the near-elderly), lesbian, gay, and bisexual adults, the unemployed, low-income workers, justice-involved individuals, homeless individuals, noncitizens, people living in households with mixed immigration status, migrant and seasonal agricultural workers, and early retirees. Other populations that experienced coverage gains include those with specific medical conditions or needs such as prescription drug users, people with substance use disorders including opioid use disorders, people with HIV, people with disabilities, low-income adults who screened positive for depression, adults with diabetes, cancer patients/survivors, adults with a history of cardiovascular disease or two or more cardiovascular risk factors, and veterans.139  140  141  142  143  144  145  146  147  148  149  150  151  152  153  154  155  156  157  158  159  160  161  162  163  164  165  166  167  168  169  170  171  172  173  174  175  176  177  178  179  180  181  182  183  184  185  186  187  188  189  190  191  192  193  194  195 

Most analyses that looked at rural/urban coverage changes find that Medicaid expansion has had a particularly large impact on Medicaid coverage or uninsured rates in rural areas. Studies have found that Medicaid expansion reduced or eliminated disparities in coverage between adults living in rural vs. urban areas. However, as noted below, research on coverage effects in rural versus urban areas was mixed.196  197  198  199 

Studies show larger Medicaid coverage gains and reductions in uninsured rates in expansion states compared to non-expansion states occurred across most or all of the major racial/ethnic categories. Additional research also suggests that Medicaid expansion has helped to reduce disparities in coverage by income, age, marital status, disability status, and, in some studies, race/ethnicity.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 

A minority of coverage studies show no effect or mixed results of expansion in certain areas. Many of these findings were included in studies that had additional findings related to coverage or disparity improvements and are also cited above. Some findings within three studies did not show greater coverage changes for rural areas. A limited number of studies found that expansion was not significantly associated with changes in the uninsured rate among certain specific groups, as Medicaid coverage gains in expansion states were offset larger private insurance gains in non-expansion states for these groups. Findings within four studies suggested that expansion was associated with an increase in coverage disparities (by gender in one study, by race/ethnicity in another, and by marital status among women in two others). In addition, one study showed no significant differences in churn rates among low-income adults between 2013 and 2015 based on the state’s expansion policy.225  226  227  228  229  230  231  232  233  234  235  236  237  238  239  240  241  242  243  244  245  246  247  248 

Private Coverage and Waiver Implications

Some studies exploring the effects of Medicaid expansion on private insurance coverage found no evidence of Medicaid expansion coverage substituting for private coverage including employer-sponsored insurance, while other studies showed declines in private coverage associated with expansion overall or among certain specific population groups. These declines in private coverage may occur if individuals previously covered through employer-sponsored or self-pay insurance opt in to Medicaid given Medicaid’s typically lower out-of-pocket costs and more comprehensive benefit packages, or if employers alter their offering of coverage in response to the expansion of Medicaid. Private coverage changes in studies that include states that expanded later than January 2014 may also reflect people above 100% FPL transitioning from subsidized Marketplace coverage to Medicaid after their state adopts the expansion.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 

States implementing the expansion with a waiver have seen similar or larger gains in coverage as states not using waivers, but research finds that some provisions in these waivers present barriers to coverage.

  • Studies show that some states initially expanding Medicaid with Section 1115 waivers experienced coverage gains that were similar to gains in states implementing traditional Medicaid expansions. Research comparing Arkansas (which expanded through a premium assistance model) and Kentucky (which expanded through a traditional, non-waiver model) showed no significant differences in uninsured rate declines between 2013 and 2015 in the two states. An analysis of expansion waiver programs in Michigan and Indiana showed that both states experienced uninsured rate reductions between 2013 and 2015 that were higher than the average decrease among expansion states as well as large gains in Medicaid enrollment.274  275  276  277  278  279 
  • A growing body of research suggests that certain Section 1115 waiver provisions that target the expansion population have caused coverage losses or presented barriers to enrollment, particularly in Arkansas related to the implementation of a Medicaid work requirement and in Indiana related to the Healthy Indiana Plan (HIP) 2.0 monthly contribution requirements.280 ,281 ,282  283  284  285  286  287  288  289  290 

Studies find positive effects of Medicaid expansion on a range of outcomes related to access (Figure 4). In addition to impacts on access to and utilization of care, studies consider the effect of expansion on quality of care, self-reported health, and health outcomes; provider capacity; and affordability and financial security.

Figure 4: Studies find that the ACA Medicaid expansion increased access across a range of measures, though findings on provider capacity are mixed.

Access to Care and Utilization

Most research demonstrates that Medicaid expansion improves access to care and increases utilization of health care services among the low-income population. Many expansion studies point to improvements across a wide range of measures of access to care as well as utilization of a variety of medications and services. Some of this research also shows that improved access to care and utilization is leading to increases in diagnoses of a range of diseases and conditions and in the number of adults receiving consistent care for a chronic condition.291  292  293  294  295  296  297  298  299  300  301  302  303  304  305  306  307  308  309  310  311  312  313  314  315  316  317  318  319  320  321  322  323  324  325  326  327  328  329  330  331  332  333  334  335  336  337  338  339  340  341  342  343  344  345  346  347  348  349  350  351  352  353  354  355  356  357  358  359  360  361  362  363  364  365  366  367  368  369  370  371  372  373  374  375  376  377  378  379  380  381  382  383  384  385  386  387  388  389  390  391  392  393  394  395  396  397  398  399  400  401  402  403  404  405  406  407  408  409  410  411  412  413  414  415  416  417  418  419  420  421  422  423  424 

For example:

  • Cancer Diagnosis and Treatment. Multiple studies found that expansion was associated with significantly greater increases in overall or Medicaid-covered cancer diagnosis rates and/or early-stage diagnosis rates. Multiple studies found an association between expansion and increased access to and utilization of certain types of cancer surgery, with one study finding a decreased disparity in expansion states between Medicaid and privately-insured patients in the odds of undergoing surgery for certain types of cancer.425  426  427  428  429  430  431  432  433  434  435  436 
  • Transplants. Additional studies found a correlation between expansion and increased heart transplant listing rates for African American adults (both overall and among Medicaid enrollees) and increased lung transplant listings for nonelderly adults.437  438 
  • Smoking Cessation. Additional research found decreased cigarette and other nicotine product purchases and increased access, utilization, and Medicaid coverage of evidence-based smoking cessation medications post-expansion in expansion states relative to non-expansion states. For example, one recent study found that Medicaid expansion lead to a 24% increase in new use of smoking cessation medication.439  440  441  442  443  444 
  • Behavioral Health. Recent evidence demonstrates that Medicaid expansion states have seen improvements in access to medications and services for the treatment of behavioral health (mental health and substance use disorder (SUD)) conditions following expansion, with many national and multi-state studies showing greater improvements in expansion compared to non-expansion states. This evidence includes studies that have shown that Medicaid expansion is associated with increases in overall prescriptions for, Medicaid-covered prescriptions for, and Medicaid spending on medications to treat opioid use disorder and opioid overdose.445  446  447  448  449  450  451  452  453  454  455  456  457  458  459  460  461  462  463  464  465  466  467  468  469  470 
    • Medication Assisted Treatment (MAT) for Treatment of Opioid Use Disorder. Multiple studies have found increases in medication assisted treatment (MAT) drug prescriptions (either overall or Medicaid-covered prescriptions) associated with expansion. Some of these studies also found that in contrast, there was no increase in opioid prescribing rates (overall or Medicaid-covered) associated with expansion over the same period. One study found that expansion was associated with an 18% increase in aggregate opioid admissions to specialty treatment facilities, nearly all of which was driven by a 113% increase in admissions from Medicaid beneficiaries.471  472  473  474  475  476  477  478  479  480 

Multiple recent studies have also found expansion to be associated with improvements in disparities by race/ethnicity, income, education level, insurance type, and employment status in measures of access to and utilization of care.481  482  483  484  485  486  487  488 

Studies point to changes in patterns of emergency department (ED) utilization. Some studies point to declines in uninsured ED visits or visit rates and increases in Medicaid-covered ED visits or visit rates in expansion states compared to non-expansion states, compared to pre-expansion, or compared to other populations within expansion states. Studies show inconsistent findings about how Medicaid expansion has affected ED volume or frequency of visits overall or among specific populations (e.g., Medicaid enrollees or frequent ED users), with some studies showing increases, no change, or declines. Studies also showed decreased reliance on the ED as a usual source of care and a shift in ED use toward visits for higher acuity conditions among individual patients who gained expansion coverage, compared to those who remained uninsured in non-expansion states.489  490  491  492  493  494  495  496  497  498  499  500  501  502  503  504  505  506 

In contrast with other studies’ findings on decreased reliance on the ED as a usual source of care, some recent studies suggest that Medicaid expansion may increase non-necessary use of certain health services. These services include hospitalization or specialty treatment for certain specific health conditions, including lupus, oral health conditions, and upper-extremity trauma. Authors explain that the non-necessary use of these services could be prevented by primary care and indicates the need for increased access to outpatient care for new enrollees.507  508  509  510 

Evidence suggests that beneficiaries and other stakeholders lack understanding of some waiver provisions designed to change utilization or improve health outcomes. Multiple studies have demonstrated confusion among beneficiaries, providers, and advocates in expansion waiver states around the basic elements of the programs or requirements for participation, as well as beneficiary reports of barriers to completion of program activities (including internet access and transportation barriers). These challenges have resulted in increased costs to beneficiaries, beneficiaries being transitioned to more limited benefit packages, low program participation, or programs not operating as intended in other ways.511  512  513  514  515  516  517 

Some study findings did not show that expansion significantly improved some measures of access, utilization, or disparities between population groups. Many of these findings were included in studies that also found related improvements in access, utilization, or disparities measures and are also cited above. Authors of some early studies using 2014 data note that changes in utilization may take more than one year to materialize. Consistent with this premise, a longer-term study found improvements in measures of access to care and financial strain in year two of the expansion that were not observed in the first year.518  519  520  521  522  523  524  525  526  527  528  529  530  531  532  533  534  535  536  537  538  539  540  541  542  543  544  545  546  547  548  549  550  551  552  553  554  555  556  557  558  559  560  561  562  563  564  565  566  567  568  569  570  571  572  573  574 

Quality of Care, Self-Reported Health, and Health Outcomes

Several studies show an association between Medicaid expansion and improvements in quality of care. These include studies focused on the low-income population broadly, academic medical center or affiliated hospital patients, or community health center patients and look at outcomes including receipt of recommended screenings or recommended care for a particular condition.575  576  577  578  579  580  581  582 

Additional studies show effects of expansion on measures of quality hospital care and outcomes. A few studies found that Medicaid expansion was associated with declines in hospital length of stay and in-hospital mortality as well as increases in hospital discharges to rehabilitation facilities, and one study found an association between expansion and declines in mechanical ventilation rates among patients hospitalized for various conditions. One recent study found that expansion was associated with decreased preventable hospitalizations, measured by reductions in annual ambulatory care-sensitive discharge rates and inpatient days. Additional analyses found that, contrary to past studies associating Medicaid insurance with longer hospital stays and higher in-hospital mortality, the shift in payer mix in expansion states (increase in Medicaid discharges and decrease in uninsured discharges) did not influence length of stay or in-hospital mortality for various types of patients.583  584  585 ,586 ,587  588  589  590  591  592  593  594  595 

Multiple studies have found improvements in measures of self-reported health or positive health behaviors following Medicaid expansions. Studies found improvements in both measures of self-reported physical and mental health, as well as increases in healthy behaviors such as self-reported diabetes management. Additional research has documented provider reports of newly eligible adults showing improved health or receiving life-saving or life-changing treatments that they could not obtain prior to expansion.596  597  598  599  600  601  602  603  604  605  606  607  608  609  610  611  612 

Studies have found an association between Medicaid expansion and improvements in certain measures of health outcomes. Studies in this area find an association between expansion and improvements in cardiac surgery patient outcomes and perforated appendix admission rates among hospitalized patients with acute appendicitis. One study did not find a significant association between expansion and differences in rates of low birth weight or preterm birth outcomes overall, but did find significant improvements in relative disparities for black infants compared with white infants in states that expanded vs. those that did not. Two studies found expansion was associated with increased odds of tobacco cessation (among adult CHC patients in one study and childless adults in the other).613  614  615  616  617  618 

Additionally, a growing body of research has found an association between Medicaid expansion and mortality, either population-level rates overall, for particular populations, or associated with certain health conditions. A 2019 national study found that expansion was associated with a 0.132 percentage point decline in annual mortality among near-elderly adults driven largely by reductions in disease-related deaths, an effect that translates to about 19,200 deaths that were averted during the first four years of expansion (or 15,600 deaths in expansion states could have been averted in non-expansion states). A 2020 study found that expansion was associated with a 6% lower rate of opioid overdose deaths. Another study suggests that expansion may have contributed to infant mortality rate reductions, finding that the mean infant mortality rate rose slightly in non-expansion states between 2014 and 2016, compared to a decline in expansion states over that period (this effect was particularly pronounced among the African-American population). Studies also found reductions in cardiovascular mortality among middle-aged adults and in one-year mortality among end-stage renal disease patients initiating dialysis.619  620  621  622  623 

Some studies did not find significant changes associated with expansion on certain measures of quality of care, self-reported health, or health outcomes.

  • Some studies did not find an association between Medicaid expansion and quality outcomes; many of these studies focused on very narrow population groups and/or found a link between expansion and improvements in quality of care for some of the patient/population groups studied. One study found no significant association between Medicaid expansion and changes in quality of care delivered through Medicaid managed care plans. The authors suggest that this finding shows that the health system has generally been able to absorb new expansion enrollees without sacrificing care for existing enrollees.624  625  626  627  628  629  630  631  632  633  634 
  • Some studies on specific hospital patient groups found no significant changes associated with expansion in measures of hospital care and outcomes, including rates of emergent admission, admissions from clinic, diagnosis category at admission, admission severity, rapid discharges, lengthy hospitalizations, unplanned readmissions, discharges to rehabilitation facilities, or failure to rescue. One study found that expansion was associated with an increase in length of stay for adult trauma patients.635  636  637  638  639  640  641  642  643  644  645  646  647  648  649 
  • A small number of studies did not find significant changes in certain measures of self-reported health status, health outcomes including mortality, wellbeing, or healthy behaviors, or in disparities between certain population groups in these measures. One study found that although Medicaid expansion was associated with increased access to opioid pain-relievers, it was not significantly associated with any change in opioid deaths. Similarly, an earlier study found no evidence of expansion affecting drug-related overdoses or fatal alcohol poisonings. A third study found that although opioid overdose mortality rates increased more in expansion states, this difference was not caused by increased prescriptions. Given that it may take additional time for measurable changes in health to occur, researchers suggest that further work is needed to provide longer-term insight into expansion’s effects on self-reported health and health outcomes.650  651  652  653  654  655  656  657  658  659  660  661  662  663  664  665  666  667  668  669  670  671  672  673  674 

Provider Capacity

Many studies conclude that providers have expanded capacity or participation in Medicaid following expansion and are meeting increased demands for care. Studies in this area include findings showing an association of expansion with increases in primary care appointment availability, the likelihood of accepting new patients with Medicaid among non-psychiatry specialist physicians, and Medicaid acceptance and market entry among select medication assisted treatment (MAT) providers. One study found improvements in receipt of checkups, care for chronic conditions, and quality of care even in areas with primary care shortages, suggesting that insurance expansions can have a positive impact even in areas with relative shortages. A survey of Medicaid managed care organizations found that over seven in ten plans operating in expansion states reported expanding their provider networks between January 2014 and December 2016 to serve the newly-eligible population.675  676  677  678  679  680  681  682  683  684  685  686  687  688  689  690  691  692  693  694  695  696  697  698  699  700  701 

Some studies on measures of provider availability showed no changes associated with expansion. Authors note that findings of no changes may, in some cases, be viewed as favorable outcomes indicating that provider availability is not worsening in expansion states despite the increased demand for care associated with expansion. For example, despite concerns that expansion might worsen access for the already-insured, two studies found that expansion was not associated with decreased physician availability for Medicare patients.702  703  704  705  706  707  708  709  710  711  712  713  714  715 

Other studies found expansion was linked to problems with provider availability. Some of these studies also had positive or insignificant findings related to provider capacity for certain populations or types of appointment with negative findings related to others. These include findings that Medicaid expansion was associated with longer wait times for appointments or increased difficulty obtaining appointments with specialists. Most of these studies use early data from 2014 and 2015.716  717  718  719  720  721  722  723  724  725  726  727 

Affordability and Financial Security

Research suggests that Medicaid expansion improves the affordability of health care. Several studies show that people in expansion states have experienced reductions in unmet medical need because of cost, with national and multi-state studies showing those reductions were greater than reductions in non-expansion states. Research also suggests that Medicaid expansion results in significant reductions in out-of-pocket medical spending, and multiple studies found larger declines in trouble paying as well as worry about paying future medical bills among people in expansion states relative to non-expansion states. A recent study in Washington state found that among trauma patients, expansion was associated with a 12.4 percentage point decrease in estimated catastrophic healthcare expenditure risk. One study found that previously uninsured prescription drug users who gained Medicaid coverage in 2014 saw, on average, a $205 reduction in annual out-of-pocket spending in 2014. A January 2018 study that focused on the 100-138% FPL population in expansion and non-expansion states also found that Medicaid expansion coverage produced greater reductions than subsidized Marketplace coverage in average total out-of-pocket spending, average out-of-pocket premium spending, and average cost-sharing spending.728  729  730  731  732  733  734  735  736  737  738  739  740  741  742  743  744  745  746  747  748  749  750  751  752  753  754  755  756  757  758  759  760  761  762  763  764  765  766  767  768  769  770  771  772  773 

  • Studies have found that Medicaid expansion significantly reduced the percentage of people with medical debt, reduced the average size of medical debt, and reduced the probability of having one or more medical bills go to collections in the past 6 months.774  775  776  777  778  779  780  781  782  783  784 
  • A study in Ohio showed lower medical debt holding levels among continuously-enrolled expansion enrollees compared to those who unenrolled from expansion and those who had a coverage gap, suggesting that medical debt levels rose even after a relatively short time without Medicaid expansion coverage.785  786 

Research also suggests an association between Medicaid expansion and improvements in broader measures of financial stability.787  788  789  790  791  792  793  794  795 

For example:

  • A study found that Medicaid expansion was associated with a 2.2 percentage point decrease in very low food security (which is characterized by actual reduction of food intake due to unaffordability) among low-income childless adults.796 
  • Two 2019 national studies looked at the association between Medicaid expansion and poverty rates. One found that expansion was associated with a reduction in the rate of poverty by just under 1 percentage point (or an estimated 690,000 fewer Americans living in poverty). The other found that Medicaid expansion was associated with a 1.7 percentage point reduction in the health-inclusive poverty measure (HIPM) poverty rate and a 0.9 percentage point reduction in the HIPM deep poverty rate that were significant across all demographic groups considered except single-parent households and were particularly substantial for vulnerable groups including children, the near-elderly (age 55-64), black people, Hispanics, and those who have not completed high school. The same study showed no significant change in the Census Bureau’s supplemental poverty measure (SPM).797  798 
  • Studies have found that Medicaid expansion significantly reduced the average number of collections, improved credit scores, reduced over limit credit card spending, reduced public records (such as evictions, bankruptcies, or wage garnishments), and reduced the probability of a new bankruptcy filing, among other improvements in measures of financial security. One 2019 study found that Medicaid expansion was associated with a 1.15 reduction in the rate of evictions per 1000 renter-occupied households and a 1.59 reduction in the rate of eviction filings.799  800  801  802  803  804 
  • A Michigan study found an association between expansion and improvements across a broad swath of financial measures.805 

Multiple studies have found expansion to be associated with improvements in disparities by income or race/ethnicity in measures of affordability of care or financial security.806  807  808  809  810  811 

Some study findings did not show significant effects of expansion on measures of affordability or financial security. Several of these studies did not identify statistically significant differences in changes in unmet medical need due to cost between expansion and non-expansion states, though authors note that some of these findings may have been affected by study design or data limitations. Other studies did not find changes associated with expansion in trouble or worry about paying medical bills. Two studies did not find improvements in disparities by race/ethnicity associated with expansion in measures of unmet care needs due to cost.812  813  814  815  816  817  818  819  820  821  822  823  824  825  826  827  828  829  830  831  832   

Economic Effects

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

Figure 5: Studies find positive effects of the ACA Medicaid expansion across a range of economic measures.

State Budgets and Economies

Analyses find effects of expansion on multiple state economic outcomes, including budget savings, revenue gains, and overall economic growth. These positive effects occurred despite Medicaid enrollment growth initially exceeding projections in many states and increases in total Medicaid spending, largely driven by increases in federal spending given the enhanced federal match rate for expansion population costs provided under the ACA (the federal share was 100% for 2014-2016). As of Summer 2019, most expansion states reported relying on general fund support to finance the state share of expansion costs, although some also use new or increased provider taxes/fees or savings accrued as a result of the expansion. While studies showed higher growth rates in total Medicaid spending (federal, state, and local) following initial expansion implementation in 2014 and 2015 compared to the previous few years, this growth rate slowed significantly beginning in 2016. There is limited research examining the fiscal effects at the federal level from the additional expenditures for the Medicaid expansion or the revenues to support that spending.833  834  835  836  837  838  839  840  841  842  843  844  845  846  847  848  849  850  851  852  853  854  855 

  • National research found that there were no significant increases in spending from state funds as a result of Medicaid expansion and no significant reductions in state spending on education, transportation, or other state programs as a result of expansion during FYs 2010-2015. During this period, the federal government paid for 100% of the cost expansion. State spending could rise as the federal matching for the expansion phases down to 90%.856 
  • Single-state studies in Louisiana and Montana showed that expansion resulted in large infusions of federal funds into the states’ economies and significant state savings. Louisiana studies showed increases in overall state and local tax receipts in 2017 and 2018. A study in Montana found positive financial effects for businesses due to infusion of federal dollars to fund health coverage for workers.857  858  859  860  861 

Multiple studies suggest that Medicaid expansion resulted in state savings by offsetting state costs in other areas, including state costs related to behavioral health services and crime and the criminal justice system. For example, a study in Montana showed offsets for state SUD spending, a study in California showed reduced county safety-net spending, and a study in Michigan pointed to state savings for non-Medicaid health programs (including the state’s community mental health system, its Adult Benefit Waiver program, and spending on health care for prisoners), which, combined with increased tax revenue associated with expansion, resulted in net fiscal benefits expected through 2021. Limited research also indicates possible federal and state savings due to decreased SSI participation associated with expansion.862  863  864  865  866  867  868  869  870  871  872  873  874  875  876 

Medicaid Spending Per Enrollee

Studies have found lower Medicaid spending per enrollee for the new ACA adult eligibility group compared to traditional Medicaid enrollees (including seniors and people with disabilities in some studies and excluding those populations in others) and that per enrollee costs for newly eligible adults have declined over time since initial implementation of the expansion.877  878  879  880  881  882  883  884 

  • One analysis found that in 2014, among those states reporting both spending and enrollment data, spending per enrollee for the new adult group was much lower than spending per enrollee for traditional Medicaid enrollees. Similarly, an analysis of 2012-2014 data from expansion states found that average monthly expenditures for newly eligible Medicaid enrollees were $180, 21% less than the $228 average for previously eligible enrollees.885  886 
  • A June 2017 study showed that per enrollee Medicaid spending declined in expansion states(-5.1%) but increased in non-expansion states (5.1%) between 2013 and 2014. Researchers attributed these trends to the ACA Medicaid expansion, which increased the share of relatively less expensive enrollees in the Medicaid beneficiary population mix in expansion states.887 

Marketplace Effects

Studies suggest that Medicaid expansion supports the ACA Marketplaces and may help to lower Marketplace premiums. Two national studies showed that Marketplace premiums were significantly lower in expansion compared to non-expansion states, with estimates ranging from 7% lower in 2015 to 11-12% lower in a later study that looked at 2015-2018 data. Another study found that the state average plan liability risk score was higher in non-expansion than expansion states in 2015 (higher risk scores are associated with sicker state risk pools and likely translate to higher premiums). A study in Arkansas showed that the “private option” expansion has helped to boost the number of carriers offering Marketplace plans statewide, generated a younger and relatively healthy risk pool in the Marketplace, and contributed to a 2% drop in the average rate of Marketplace premiums between 2014 and 2015. A study of New Hampshire’s Premium Assistance Program (PAP) population (Medicaid expansion population enrolled in the Marketplace), however, showed higher medical costs for the PAP population compared to other Marketplace enrollees.888  889  890  891  892 

Impacts on Hospitals and Other Providers

Research shows that Medicaid expansions result in reductions in uninsured hospital, clinic, or other provider visits and uncompensated care costs, whereas providers in non-expansion states have experienced little or no decline in uninsured visits and uncompensated care. One study suggested that Medicaid expansion cut every dollar that a hospital in an expansion state spent on uncompensated care by 41 cents between 2013 and 2015, corresponding to a reduction in uncompensated care costs across all expansion states of $6.2 billion over that period.893  894  895  896  897  898  899  900  901  902  903  904  905  906  907  908  909  910  911  912  913  914  915  916  917  918  919  920  921  922  923  924  925  926  927  928  929  930  931  932  933  934  935  936  937  938  939  940  941  942  943  944  945  946  947  948  949  950  951  952  953  954  955  956  957  958  959  960  961  962  963  964  965  966  967  968  969  970  971  972  973  974  975  976 

  • Some studies point to changes in payer mix within emergency departments (EDs), specifically. Multiple studies found significant declines in uninsured ED visits and increases in Medicaid-covered ED visits following expansion implementation. In addition, one study found that expansion was associated with a 6.3% increase in ED physician reimbursement per visit in states that newly expanded coverage for adults from 0% to 138% FPL compared to non-expansion states.977  978  979  980  981  982  983  984  985  986  987  988  989  990 
  • Multiple studies found an association between expansion and significant increases in Medicaid coverage of patients/treatment at specialty substance use disorder (SUD) treatment facilities or treatment programs, with two studies also showing associated decreases in the probability that patients at these facilities were uninsured. An additional study found large shifts in sources of payment for SUD treatment among justice-involved individuals following Medicaid expansion in 2014, with significant increases in those reporting Medicaid as the source of payment.991  992  993  994  995 
  • Numerous recent studies found an association between expansion and payer mix (decreases in uninsured patients and increases in Medicaid patients) among patients hospitalized for certain specific conditions, including a range of cardiovascular conditions and operations; diabetes-related conditions; traumatic injury; and cancer surgery. Another analysis found expansion was associated with increases in Medicaid patient admissions for five of the eight types of cancer included in the study. Additional studies found that expansion was associated with increases in the proportion of transplant listings (for lung, liver, and pre-emptive kidney transplants, especially among racial and ethnic minorities) with Medicaid coverage, as well as increases in the proportion of received pre-emptive kidney transplantations that were covered by Medicaid. Two additional studies also found an increase in the chances of enrolling in Medicaid during post-liver transplant care. A study using birth certificate data found that expansion was associated with an increased proportion of deliveries covered by Medicaid, which was offset by a decrease in the proportion covered by private insurers or other payers but no change in the proportion of women who were uninsured.996  997  998  999  1000  1001  1002  1003  1004  1005  1006  1007  1008  1009  1010  1011  1012  1013  1014  1015  1016  1017  1018 
  • Studies found that expansion’s impact on payer mix and uncompensated care varied by the type and location of hospital. Two studies found larger decreases in uncompensated care and increases in Medicaid revenue among hospitals that treat a disproportionate share of low-income patients (DSH hospitals) compared to those that do not. A third study found no significant association of Medicaid expansion with changes in charge-to-cost ratio for certain surgical procedures in safety net hospitals vs. non-safety net hospitals, suggesting that safety net hospitals did not increase charges to private payers in response to expansion-related payer mix changes. A fourth study found that Medicaid expansion was significantly associated with increased Medicaid-covered discharges for rural hospitals but not for urban hospitals, but that urban hospitals saw significant reductions in uncompensated care costs while rural hospitals did not.1019  1020  1021  1022 

Additional studies demonstrate that Medicaid expansion has significantly improved operating margins and financial performances for hospitals, other providers, and managed care organizations. A study published in January 2018 found that Medicaid expansion was associated with improved hospital financial performance and significant reductions in the probability of hospital closure, especially in rural areas and areas with higher pre-ACA uninsured rates. Another analysis found that expansion’s effects on margins were strongest for small hospitals, for-profit and non-federal-government-operated hospitals, and hospitals located in non-metropolitan areas. A third study found larger expansion-related improvements in operating margins for public (compared to nonprofit or for-profit) hospitals and rural (compared to non-rural) hospitals.1023  1024  1025  1026  1027  1028  1029  1030  1031  1032  1033  1034  1035 

  • A study of Ascension Health hospitals nationwide found that the decrease in uncompensated care costs for hospitals in expansion states was greater than the increase in Medicaid shortfalls between 2013 and 2014, whereas for hospitals in non-expansion states, the increase in Medicaid shortfalls exceeded the decrease in uncompensated care.1036 
  • A survey of Medicaid managed care organizations found that nearly two-thirds of plans in expansion states reported that the expansion has had a positive effect on their financial performance.1037 
  • Recent studies on the association between expansion and hospital costs or charges for specific conditions have found mixed results. One study found expansion was associated with increased diagnosis-related group charges for lupus hospitalizations, but another study found an association between expansion and reduced hospital costs for ambulatory care-sensitive conditions and a third found lower total index hospital charges within the homeless population in expansion states. An additional study found that hospital costs for minimally-invasive surgical care decreased for Medicaid-insured patients in expansion states, but increased for uninsured/self-pay patients.1038  1039  1040  1041 

Some research suggests that savings to providers following expansion may be partially offset by increases in Medicaid shortfalls (the difference between what Medicaid pays and the cost of care for Medicaid patients). One recent study found that while expansion led to substantial reductions in hospitals’ uncompensated care costs, savings were offset somewhat by increased Medicaid payment shortfalls (increases were greater in expansion relative to non-expansion states).1042 

Employment and Labor Market Effects

State-specific studies have documented significant job growth resulting from expansion. Studies in Louisiana found that in FY 2017, the injection of federal expansion funds created and supported 19,195 jobs (while creating and supporting personal earnings of $1.12 billion) in sectors throughout the economy and across the state; in FY 2018, continued federal healthcare spending supported 14,263 jobs and $889.0 million in personal earnings. A study in Colorado found that the state supported 31,074 additional jobs due to Medicaid expansion as of FY 2015-2016.1043  1044  1045  1046  1047 

Some studies found expansion was linked to increased employment. National research found increases in the share of individuals with disabilities reporting employment and decreases in the share reporting not working due to a disability in Medicaid expansion states following expansion implementation, with no corresponding trends observed in non-expansion states; other research found a decline in participation in Supplemental Security Income, which requires people to demonstrate having a work-limiting disability and limits their allowable earned income. Another national study found evidence that for many of the demographic groups included in the analysis, expansion was associated with an increase in labor force participation and employment. The study also found a significant decrease in involuntary part-time work for both the full population sample and the sample of those with incomes at or below 138% FPL. A multi-state study found that by the fourth year of expansion, growth in total employment was 1.3 percentage points higher and employment growth in the health care sector was 3.2 percentage points higher in the expansion states studied than in non-expansion states.1048  1049  1050  1051  1052  1053 

Multiple studies showed that expansion supported enrollees’ ability to work, seek work, or volunteer. Single-state studies in Ohio and Michigan showed that large percentages of expansion beneficiaries reported that Medicaid enrollment made it easier to seek employment (among those who were unemployed but looking for work) or continue working (among those who were employed). The Michigan study found that 69% of enrollees who were working said they performed better at work once they got expansion coverage. Another study found that 46% of primary care physicians surveyed in Michigan reported that Michigan’s Medicaid expansion had a positive impact on patients’ ability to work. An additional study in Michigan found that enrollees who reported improved health due to expansion were more likely to say that expansion coverage improved their ability to work and to seek a new job. In addition, a national study found an association between Medicaid expansion and volunteer work (both formal volunteering for organizations and informally helping a neighbor), with significant increases in volunteer work occurring among low-income individuals in expansion states in the post-expansion period (through 2015) but no corresponding increase in non-expansion states. The researchers connect this finding to previous literature showing an association between improvements in individual health and household financial stabilization and an increased likelihood of volunteering.1054  1055  1056  1057  1058 

Some studies found no effects of expansion on some measures of employment or employee behavior; just one study found a negative effect of expansion on these measures. Measures in this area that showed no changes related to expansion in some studies include measures of employment rates, transitions from employment to non-employment, the rate of job switches, transitions from full- to part-time employment, labor force participation, usual hours worked per week, self-employment, and Supplemental Security Income applications. Authors of two studies note that expansion had no effect on employment and job-seeking despite concerns that the availability of free non-employer health insurance could be a disincentive to finding employment. A 2019 study comparing pairs of bordering counties in expansion and non-expansion states found that expansion was associated with a temporary 1.2% decrease in employment one year after implementation (although this effect did not persist two years after expansion) and no effect on wages at any point.1059  1060  1061  1062  1063  1064  1065  1066  1067  1068 

Emerging Studies

Medicaid expansion was associated with a statistically significant decrease in reported cases of neglect for children younger than six years, but no significant change in rates of physical abuse for children under six. Another 2019 study found that Medicaid expansion was associated with increased undercounting of Medicaid enrollment in the American Community Survey. A 2017 study found that expansion was negatively associated with the prevalence of divorce among those ages 50-64 and infers that this likely indicates a reduction in medical divorce. A study found that expansion was not associated with increased migration from non-expansion states to expansion states in 2014, indicating that individuals did not migrate in order to gain access to Medicaid benefits. An additional group of studies suggests that Medicaid expansion may have significant effects on measures related to individuals’ political activity and views. Specifically, studies show associations between Medicaid expansion and increases in voter registration, ACA favorability, and gubernatorial approval. One study found that the increase in Medicaid enrollment following Medicaid expansion was associated with increases in voter turnout for U.S. House races in 2014 compared to 2012 (i.e., a reduction in the size of the usual midterm drop-off in turnout), but another study showed only weak evidence of a potential turnout effect of expansion in the 2014 election, and a consistent lack of any impact on turnout in 2016.1069  1070  1071  1072 1073  1074  1075  1076  1077 

The authors thank Larisa Antonisse for her work on previous versions of this brief and assistance with reviewing recently published studies included in this update, as well as Eva Allen from The Urban Institute for her assistance with reviewing studies first included in an earlier version of this brief.

Appendix

Coverage Effects of Expansion

NATIONWIDE STUDIES (back to top)

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  3. Jennifer M. Lobo et al., “Trends in Uninsured Rates Before and After Medicaid Expansion in Counties Within and Outside of the Diabetes Belt,” Diabetes Care Epub ahead of print (January 2020), https://doi.org/10.2337/dc19-0874
  4. Scott R. Sanders et al., “Infants Without Health Insurance: Racial/Ethnic and Rural/Urban Disparities in Infant Households’ Insurance Coverage,” PLoS One 15, no. 1 (January 2020), https://doi.org/10.1371/journal.pone.0222387
  5. Helmneh M. Sineshaw et al., “Association of Medicaid Expansion Under the Affordable Care Act With Stage at Diagnosis and Time to Treatment Initiation for Patients With Head and Neck Squamous Cell Carcinoma,” JAMA Otolaryngology–Head & Neck Surgery Epub ahead of print (January 2020), https://doi.org/10.1001/jamaoto.2019.4310
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  7. Michel Boudreaux, James M. Noon, Brett Fried, and Joanne Pascale, “Medicaid Expansion and the Medicaid Undercount in the American Community Survey,” Health Services Research 54, no. 6 (December 2019): 1263-1272, https://doi.org/10.1111/1475-6773.13213
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  19. Taylor Kelley, Renuka Tipirneni, and Helen Levy, “Changes in Veterans’ Coverage and Access to Care Following the Affordable Care Act, 2011-2017,” American Journal of Public Health 109, no. 9 (September 2019): 1233-1235, https://doi.org/10.2105/ajph.2019.305160
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  21. Charles J. Courtemanche et al., The Impact of the ACA on Insurance Coverage Disparities After Four Years (National Bureau of Economic Research, Working Paper No. 26157, August 2019), http://www.nber.org/papers/w26157
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  23. Laura Skopec, John Holahan, and Caroline Elmendorf, Health Insurance Coverage Declined for Nonelderly Americans Between 2016 and 2017, Primarily in States That Did Not Expand Medicaid (Washington, DC: The Urban Institute, August 2019), https://www.urban.org/research/publication/health-insurance-coverage-declined-nonelderly-americans-between-2016-and-2017-primarily-states-did-not-expand-medicaid
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  26. Kevin N. Griffith, “Changes in Insurance Coverage and Access to Care for Young Adults in 2017,” Journal of Adolescent Health Epub ahead of print (July 2019), https://doi.org/10.1016/j.jadohealth.2019.05.020
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  28. Sarah Miller, Sean Altekruse, Norman Johnson, and Laura R. Wherry, Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data (National Bureau of Economic Research, Working Paper No. 26081, July 2019), http://www.nber.org/papers/w26081
  29. Jim P. Stimpson et al., “Association of Medicaid Expansion With Health Insurance Coverage Among Persons With a Disability,” JAMA Network Open 2, no. 7 (July 2019), https://doi.org/10.1001/jamanetworkopen.2019.7136
  30. Ameen Barghi, Hugo Torres, Nancy Kressin, and Danny McCormick, “Coverage and Access for Americans with Cardiovascular Disease or Risk Factors After the ACA: a Quasi-experimental Study,” Journal of General Internal Medicine epub ahead of print (June 2019), https://link.springer.com/article/10.1007%2Fs11606-019-05108-1
  31. Emily Brown, Michelle Garrison, Hao Bao, Pingping Qu, Carole Jenny, and Ali Rowhani-Rahbar, “Assessment of Rates of Child Maltreatment in States With Medicaid Expansion vs States Without Medicaid Expansion,” JAMA Network Open 2, no. 6 (June 2019), https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2735758
  32. Ankit Agarwal, Aaron Katz, and Ronald Chen, “The Impact of the Affordable Care Act on Disparities in Private and Medicaid Insurance Coverage among Patients Under 65 with Newly Diagnosed Cancer,” International Journal of Radiation Oncology, Biology, Physics (May 2019), https://www.redjournal.org/article/S0360-3016(19)30783-7/pdf
  33. Robin Cohen, Emily Terlizzi, and Michael Martinez, Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2018 (National Center for Health Statistics, May 2019), https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201905.pdf
  34. Sarah Miller and Laura Wherry, “Four Years Later: Insurance Coverage and Access to Care Continue to Diverge between ACA Medicaid Expansion and Non-Expansion States,” American Economic Association Papers and Proceedings 109 (May 2019): 327-333, https://www.aeaweb.org/articles?id=10.1257/pandp.20191046
  35. Joanna Woronkowicz, Aparna Soni, Seth Freedman, and Kosali Simon, “How Have Recent Health Insurance Expansions Affected Coverage Among Artist Occupations In The USA?,” Journal of Cultural Economics (May 2019), https://link.springer.com/article/10.1007/s10824-019-09352-5
  36. Abeer Alharbi, M. Mahmud Khan, Ronnie Horner, Heather Brandt, and Cole Chapman, “Impact Of Medicaid Coverage Expansion Under The Affordable Care Act On Mammography And Pap Tests Utilization Among Low-Income Women,” PLOS One (April 2019), https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214886
  37. Helen Levy, Thomas Buchmueller, and Sayeh Nikpay, “The Impact of Medicaid Expansion on Household Consumption,” Eastern Economic Journal 45, no. 1 (January 2019): 34-57, https://link.springer.com/article/10.1057/s41302-018-0124-7
  38. Colleen M. Carey, Sarah Miller, and Laura R. Wherry, “The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare,” National Bureau of Economic Research Working Paper Series No. 25153 (October 2018), https://www.nber.org/papers/w25153
  39. Charles Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata, and Ishtiaque Fazlul, “The Three‐Year Impact of the Affordable Care Act on Disparities in Insurance Coverage,” Health Services Research (October 2018), https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.13077
  40. Hyunjung Lee and Frank Porell, “The Effect of the Affordable Care Act Medicaid Expansion on Disparities in Access to Care and Health Status,” Medical Care Research and Review epub ahead of print (October 2018), https://journals.sagepub.com/doi/abs/10.1177/1077558718808709?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=mcrd
  41. Jim Stimpson and Fernando Wilson, “Medicaid Expansion Improved Health Insurance Coverage For Immigrants, But Disparities Persist,” Health Affairs 37, no. 10 (October 2018), https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0181
  42. Christian Wolfe, Kathryn Rennie, and Christopher Truffer, 2017 Actuarial Report on the Financial Outlook for Medicaid (Office of the Actuary, Centers for Medicare and Medicaid Services, September 2018), https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/MedicaidReport2017.pdf
  43. Xuesong Han, Robin Yabroff, Elizabeth Ward, Otis Brawley, and Ahmedin Jemal, “Comparison of Insurance Status and Diagnosis Stage Among Patients With Newly Diagnosed Cancer Before vs After Implementation of the Patient Protection and Affordable Care Act,” JAMA Oncology 4, no. 12 (August 2018): 1713-1720, https://jamanetwork.com/journals/jamaoncology/article-abstract/2697226
  44. Mark Olfson, Melanie Wall, Colleen Barry, Christine Mauro, and Ramin Mojtabai, “Impact Of Medicaid Expansion On Coverage And Treatment Of Low-Income Adults With Substance Use Disorders,” Health Affairs 37, no. 8 (August 2018), https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.0124
  45. Jessica Vistnes and Joel Cohen, “Duration of Uninsured Spells For Nonelderly Adults Declined After 2014,” Health Affairs 37, no. 6 (June 2018), https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.1638
  46. Adele Shartzer, Frederic Blavin, and John Holohan, “Employer-Sponsored Insurance Stable For Low-Income Workers In Medicaid Expansion States,” Health Affairs 37, no. 4 (April 2018), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.1205
  47. Amy Davidoff et al., “Changes in Health Insurance Coverage Associated With the Affordable Care Act Among Adults With and Without a Cancer History: Population-based National Estimates,” Medical Care 56, no. 3 (March 2018), https://journals.lww.com/lww-medicalcare/Abstract/2018/03000/Changes_in_Health_Insurance_Coverage_Associated.5.aspx
  48. Kevin Callison and Paul Sicilian, “Economic Freedom and the Affordable Care Act: Medicaid Expansions and Labor Mobility by Race and Ethnicity,” Public Finance Review 46, no. 2 (March 2018), https://journals.sagepub.com/doi/abs/10.1177/1091142116668254
  49. Michael Cohen and William Schpero, “Household Immigration Status Had Differential Impact On Medicaid Enrollment In Expansion And Nonexpansion States,” Health Affairs 37, no. 3 (March 2018), https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2017.0978
  50. Joshua Clinton and Michael Sances, “The Politics of Policy: The Initial Mass Political Effects of Medicaid Expansion in the States,” American Political Science Review 112, no. 1 (February 2018): 167-185, https://www.cambridge.org/core/journals/american-political-science-review/article/politics-of-policy-the-initial-mass-political-effects-of-medicaid-expansion-in-the-states/246AA0F10B44EFD62A7B27C661730823
  51. Emily Johnston, Andrea Strahan, Peter Joski, Anne Dunlop, and E. Kathleen Adams, “Impacts of the Affordable Care Act’s Medicaid Expansion on Women of Reproductive Age,” Women’s Health Issues, 28, no. 2 (February 2018), http://www.whijournal.com/article/S1049-3867(17)30242-6/pdf
  52. Dahai Yue, Petra Rasmussen, and Ninez Ponce, “Racial/Ethnic Differential Effects of Medicaid Expansion on Health Care Access,” Health Services Research (February 2018), http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12834/abstract
  53. Frederic Blavin, Michael Karpman, Genevieve Kenney, and Benjamin Sommers, “Medicaid Versus Marketplace Coverage for Near-Poor Adults: Effects on Out-Of-Pocket Spending and Coverage,” Health Affairs 37 no. 2 (January 2018): 122-129 https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.1166
  54. Lindsey Dawson, Jennifer Kates, and Anthony Damico, The Affordable Care Act and Insurance Coverage Changes by Sexual Orientation (Washington, DC: Kaiser Family Foundation, January 2018), https://www.kff.org/disparities-policy/issue-brief/the-affordable-care-act-and-insurance-coverage-changes-by-sexual-orientation/
  55. Jennifer Haley, Robin Wang, Matthew Buettgens, and Genevieve Kenney, Health Insurance Coverage among Children Ages 3 and Younger and Their Parents in 2016 (The Urban Institute, January 2018), https://www.urban.org/research/publication/health-insurance-coverage-among-children-ages-3-and-younger-and-their-parents-2016
  56. Aparna Soni, Lindsay Sabik, Kosali Simon, and Benjamin Sommers, “Changes in Insurance Coverage Among Cancer Patients Under the Affordable Care Act,” Journal of the American Medical Association 4, no. 1 (January 2018): 122-124, https://jamanetwork.com/journals/jamaoncology/article-abstract/2657670?redirect=true&redirect=true
  57. Susan Hayes, Sara Collins, David Radley, and Douglas McCarthy, What’s at Stake: States’ Progress on Health Coverage and Access to Care, 2013-2016 (The Commonwealth Fund, December 2017), http://www.commonwealthfund.org/publications/issue-briefs/2017/dec/states-progress-health-coverage-and-access
  58. Ahmedin Jemal, Chun Chieh Lin, Amy Davidoff, and Xuesong Han, “Changes in Insurance Coverage and Stage at Diagnosis Among Nonelderly Patients with Cancer after the Affordable Care Act,” Journal of Clinical Oncology 35, no. 35 (December 2017), http://ascopubs.org/doi/pdf/10.1200/JCO.2017.73.7817
  59. Thomas Selden, Brandy Lipton, and Sandra Decker, “Medicaid Expansion and Marketplace Eligibility Both Increased Coverage, With Trade-Offs in Access, Affordability,” Health Affairs 36 no. 12 (December 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0830
  60. Michael Dworsky, Carrie Farmer, and Mimi Shen, Veterans’ Health Insurance Coverage Under the Affordable Care Act and Implications of Repeal for the Department of Veterans Affairs, (RAND Corporation, 2017), https://www.rand.org/pubs/research_reports/RR1955.html
  61. Samantha Artiga, Barbara DiPietro, and Petry Ubri, The Role of Medicaid and the Impact of the Medicaid Expansion for Veterans Experiencing Homelessness, (Washington, DC: Kaiser Family Foundation, October 2017), https://www.kff.org/medicaid/issue-brief/the-role-of-medicaid-and-impact-of-the-medicaid-expansion-for-veterans-experiencing-homelessness/
  62. Sunha Choi, Sungkyu Lee, and Jason Matejkowski, “The Effects of State Medicaid Expansion on Low-Income Individuals’ Access to Health Care: Multilevel Modeling,” Population Health Management epub ahead of print (September 2017), http://online.liebertpub.com/doi/abs/10.1089/pop.2017.0104
  63. Julie Hudson and Asako Moriya, “Medicaid Expansion for Adults Had Measureable ‘Welcome Mat’ Effects on Their Children,” Health Affairs, 36 no. 9 (September 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0347
  64. Sharon Long, Lea Bart, Michael Karpman, Adele Shartzer, and Stephen Zuckerman, “Sustained Gains in Coverage, Access, and Affordability Under the ACA: A 2017 Update,” Health Affairs 36 no. 9 (September 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0798
  65. Haley Moss, Laura Havrilesky, and Junzo Chino, “Insurance Coverage Among Women Diagnosed with a Gynecologic Malignancy Before and After Implementation of the Affordable Care Act,” Gynecologic Oncology 146, no. 3 (September 2017), https://www.ncbi.nlm.nih.gov/pubmed/28641821
  66. Kevin Griffith, Leigh Evans, and Jacob Bor, “The Affordable Care Act Reduced Socioeconomic Disparities in Health Care Access,” Health Affairs 36 no. 8 (August 2017), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0083
  67. Susan Hayes, Pamela Riley, David Radley, and Douglas McCarthy, Reducing Racial and Ethnic Disparities in Access to Care: Has the Affordable Care Act Made a Difference? (The Commonwealth Fund, August 2017), http://www.commonwealthfund.org/publications/issue-briefs/2017/aug/racial-ethnic-disparities-care
  68. Aaron Sojourner and Ezra Golberstein, “Medicaid Expansion Reduced Unpaid Medical Debt and Increased Financial Satisfaction,” Health Affairs (July 2017), https://www.healthaffairs.org/do/10.1377/hblog20170724.061160/full/
  69. MaryBeth Musumeci, Priya Chidambaram, and Molly O’Malley Watts, Key Questions About Medicaid Home and Community-Based Services Waiver Waiting Lists (Washington, DC: Kaiser Family Foundation, April 2019), https://www.kff.org/medicaid/issue-brief/key-questions-about-medicaid-home-and-community-based-services-waiver-waiting-lists/
  70. Rene Flores and Robert Vargas, “Medicaid Expansion And Ethnoracial Disparities In Health Insurance Coverage,” Journal of Ethnic and Migration Studies 43, no. 12 (June 2017), https://www.tandfonline.com/doi/full/10.1080/1369183X.2017.1323451?needAccess=true
  71. Sergio Gonzales and Benjamin Sommers, “Intra-Ethnic Coverage Disparities among Latinos and the Effects of Health Reform” Health Services Research epub ahead of print (June 2017), http://onlinelibrary.wiley.com/wol1/doi/10.1111/1475-6773.12733/full
  72. Abigail Barker, Kelsey Huntzberry, Timothy McBride, and Keith Mueller, Changing Rural and Urban Enrollment in State Medicaid Programs (Iowa City, IA: Rural Policy Research Institute, May 2017), https://cph.uiowa.edu/rupri/publications/policybriefs/2017/Changing%20Rural%20and%20Urban%20Enrollment%20in%20State%20Medicaid%20Programs.pdf
  73. Sandra Decker, Brandy Lipton, and Benjamin Sommers, “Medicaid Expansion Coverage Effects Grew in 2015 With Continued Improvements in Coverage Quality,” Health Affairs 36 no. 5 (May 2017): 819-825, http://content.healthaffairs.org/content/36/5/819.full
  74. Stacey McMorrow, Jason Gates, Sharon Long, and Genevieve Kenney, “Medicaid Expansion Increased Coverage, Improved Affordability, and Reduced Psychological Distress for Low-Income Parents,” Health Affairs 36 no. 5 (May 2017): 808-818, https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1650
  75. George Wehby and Wei Lyu, “The Impact of the ACA Medicaid Expansions on Health Insurance Coverage through 2015 and Coverage Disparities by Age, Race/Ethnicity, and Gender” Health Services Research epub ahead of print (May 2017), http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12711/abstract
  76. Julia Foutz, Samantha Artiga, and Rachel Garfield, The Role of Medicaid in Rural America (Washington, DC: Kaiser Family Foundation, April 2017), http://kff.org/medicaid/issue-brief/the-role-of-medicaid-in-rural-america/
  77. Jennifer Haley, Genevieve Kenney, and Jason Gates, Veterans Saw Broad Coverage Gains Between 2013 and 2015 (Washington, DC: The Urban Institute, April 2017), http://www.urban.org/research/publication/veterans-saw-broad-coverage-gains-between-2013-and-2015
  78. Brandy Lipton, Sandra Decker, and Benjamin Sommers, “The Affordable Care Act Appears to Have Narrowed Racial and Ethnic Disparities in Insurance Coverage and Access to Care Among Young Adults” Medical Care Research and Review 76, no.1 (April 2017): 32–55, https://www.ncbi.nlm.nih.gov/pubmed/29148341
  79. Stacey McMorrow, Genevieve Kenney, Sharon Long, and Jason Gates, The ACA Medicaid Expansion Led to Widespread Reductions in Uninsurance Among Poor Childless Adults (The Urban Institute, April 2017), http://www.urban.org/sites/default/files/publication/89536/2001222-aca_medicaid_expansion_led_to_widespread_reductions_in_uninsurance_among_poor_childless_adults.pdf
  80. Charles Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata, Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health (National Bureau of Economic Research, Working Paper no. 23269, March 2017), http://www.nber.org/papers/w23269
  81. Sarah Miller and Laura Wherry, “Health and Access to Care During the First 2 Years of the ACA Medicaid Expansions,” The New England Journal of Medicine 376 no. 10 (March 2017), http://www.nejm.org/doi/full/10.1056/NEJMsa1612890
  82. Kosali Simon, Aparna Soni, and John Cawley, “The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions” Journal of Policy Analysis and Management 36, no. 2 (March 2017), https://onlinelibrary.wiley.com/doi/abs/10.1002/pam.21972
  83. Jennifer Kates and Lindsey Dawson, Insurance Coverage Changes for People with HIV Under the ACA (Washington, DC: Kaiser Family Foundation, February 2017), http://kff.org/health-reform/issue-brief/insurance-coverage-changes-for-people-with-hiv-under-the-aca/
  84. Sandra Decker and Brandy Lipton, “Most Newly Insured People in 2014 Were Long-Term Uninsured,” Health Affairs 36 no. 1 (January 2017): 16-20, http://content.healthaffairs.org/content/36/1/16.full?sid=982b20c0-0a17-4dc4-a35a-b0302d4ec289
  85. Anne Martin et al., “National Health Spending: Faster Growth in 2015 As Coverage Expands and Utilization Increases,” Health Affairs 36 no. 1 (January 2017): 166-176, http://content.healthaffairs.org/content/36/1/166.full?sid=982b20c0-0a17-4dc4-a35a-b0302d4ec289
  86. Aparna Soni, Michael Hendryx, and Kosali Simon, “Medicaid Expansion under the Affordable Care Act and Insurance Coverage in Rural and Urban Areas,” The Journal of Rural Health epub ahead of print (January 2017), http://onlinelibrary.wiley.com/doi/10.1111/jrh.12234/full
  87. Tyler Winkelman, Edith Kieffer, Susan Goold, Jeffrey Morenoff, Kristen Cross, and John Ayanian, “Health Insurance Trends and Access to Behavioral Health Care Among Justice-Involved Individuals,” Journal of General Internal Medicine 31, no. 12 (December 2016): 1523-1529, https://www.ncbi.nlm.nih.gov/pubmed/27638837
  88. Kamyar Nasseh and Marko Vujicic, Early Impact of the Affordable Care Act’s Medicaid Expansion on Dental Care Use (Health Services Research, November 2016), http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12606/full
  89. Stacey McMorrow, Genevieve Kenney, Sharon Long, and Jason Gates, “Marketplaces Helped Drive Coverage Gains in 2015; Affordability Problems Remained,” Health Affairs 35 no. 10 (October 2016): 1810-1815, http://content.healthaffairs.org/content/35/10/1810.full
  90. Robin Rudowitz, Allison Valentine, and Vernon Smith, Medicaid Enrollment and Spending Growth: FY 2016 & 2017 (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, October 2016), http://kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2016-2017/
  91. Jessica Vistnes and Joel Cohen, “Gaining Coverage in 2014: New Estimates of Marketplace and Medicaid Transitions,” Health Affairs 35 no. 10 (October 2016): 1825-1829, http://content.healthaffairs.org/content/35/10/1825.full?sid=cc385dd5-9c95-4ee1-9c58-888408d49c54
  92. Kelsey Avery, Kenneth Finegold, and Amelia Whitman, Affordable Care Act Has Led to Historic, Widespread Increase in Health Insurance Coverage (Office of the Assistant Secretary for Planning and Evaluation, September 2016), https://aspe.hhs.gov/sites/default/files/pdf/207946/ACAHistoricIncreaseCoverage.pdf
  93. Helen Levy, Thomas Buchmueller, and Sayeh Nikpay, Health Reform and Health Insurance Coverage of Early Retirees (Ann Arbor, MI: University of Michigan Retirement Research Center Working Paper, September 2016), http://www.mrrc.isr.umich.edu/publications/papers/pdf/wp345.pdf
  94. Andrew Mulcahy, Christine Eibner, and Kenneth Finegold, “Gaining Coverage Through Medicaid Or Private Insurance Increased Prescription Use and Lowered Out-Of-Pocket Spending,” Health Affairs 35, no. 9 (September 2016), http://content.healthaffairs.org/content/early/2016/08/16/hlthaff.2016.0091.full
  95. Pauline Leung and Alexandre Mas, Employment Effects of the ACA Medicaid Expansions (Working Paper No. 22540, National Bureau of Economic Research, August 2016), http://www.nber.org/papers/w22540
  96. Office of the Assistant Secretary for Planning and Evaluation (ASPE), Impacts of the Affordable Care Act’s Medicaid Expansion on Insurance Coverage and Access to Care (Office of the Assistant Secretary for Planning and Evaluation, June 2016), https://aspe.hhs.gov/sites/default/files/pdf/205141/medicaidexpansion.pdf
  97. Brendan Saloner, Sachini Bandara, Emma McGinty, and Colleen Barry, “Justice-Involved Adults With Substance Use Disorders: Coverage Increased but Rates of Treatment Did Not in 2014,” Health Affairs 35 no. 6 (June 2016), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.0005
  98. Alanna Williamson, Larisa Antonisse, Jennifer Tolbert, Rachel Garfield, and Anthony Damico, ACA Coverage Expansions and Low-Income Workers (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, June 2016), http://kff.org/report-section/aca-coverage-expansions-and-low-income-workers-issue-brief/
  99. Thomas Buchmueller, Zachary Levinson, Helen Levy, and Barbara Wolfe, “Effect of the Affordable Care Act on Racial and Ethnic Disparities in Health Insurance Coverage,” American Journal of Public Health (May 2016), http://www.ncbi.nlm.nih.gov/pubmed/27196653
  100. Sara Collins, Munira Gunja, Michelle Doty, and Sophie Beutel, Americans’ Experiences with ACA Marketplace and Medicaid Coverage: Access to Care and Satisfaction (The Commonwealth Fund, May 2016), http://www.commonwealthfund.org/publications/issue-briefs/2016/may/aca-tracking-survey-access-to-care-and-satisfaction
  101. Michael Karpman, Jason Gates, Genevieve Kenney, Stacey McMorrow, How Are Moms Faring under the Affordable Care Act? Evidence Through 2014, (The Urban Institute, May 2016), http://www.urban.org/research/publication/how-are-moms-faring-under-affordable-care-act-evidence-through-2014
  102. Genevieve Kenney, Jennifer Haley, Clare Pan, Victoria Lynch, and Matthew Buettgens, Children’s Coverage Climb Continues: Uninsurance and Medicaid/CHIP Eligibility and Participation Under the ACA, (Washington, DC: The Urban Institute, May 2016), http://www.urban.org/research/publication/childrens-coverage-climb-continues-uninsurance-and-medicaidchip-eligibility-and-participation-under-aca
  103. Jessica Sharac, Rachel Gunsalus, Chi Tran, Peter Shin, and Sara Rosenbaum, How are Migrant Health Centers and their Patients Faring Under the Affordable Care Act? (Geiger Gibson/RCHN Community Health Foundation Research Collaborative, The George Washington University Milken Institute of Public Health, May 2016), http://www.rchnfoundation.org/wp-content/uploads/2016/05/Migrant-Health-Centers-Patients-Under-Affordable-Care-Act.pdf
  104. John Cawley, Aparna Soni, and Kosali Simon, “Third Year of Survey Data Shows Continuing Benefits of Medicaid Expansions for Low-Income Childless Adults in the U.S.,” Journal of General Internal Medicine 33, no. 9 (September 2018): 1495-1497, https://link.springer.com/article/10.1007%2Fs11606-018-4537-0
  105. Charles Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, and Daniela Zapata, Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States (Working Paper No. 22182, The National Bureau of Economic Research, April 2016), http://www.nber.org/papers/w22182
  106. Molly Frean, Jonathan Gruber, and Benjamin Sommers, Premium Subsidies, the Mandate, and Medicaid Expansion: Coverage Effects of the Affordable Care Act (Working Paper No. 22213, National Bureau of Economic Research, April 2016), http://www.nber.org/papers/w22213?utm_campaign=ntw&utm_medium=email&utm_source=ntw
  107. Laura Wherry and Sarah Miller, “Early Coverage, Access, Utilization, and Health Effects Associated with the Affordable Care Act Medicaid Expansions: A Quasi-experimental Study,” Annals of Internal Medicine, Epub ahead of print (April 2016), http://annals.org/article.aspx?articleid=2513980
  108. Centers for Medicare and Medicaid Services, Monthly Medicaid and CHIP Application, Eligibility, Determination, and Enrollment Reports, (Centers for Medicare and Medicaid Services, March 2016), https://www.medicaid.gov/medicaid-chip-program-information/program-information/medicaid-and-chip-enrollment-data/medicaid-and-chip-application-eligibility-determination-and-enrollment-data.html
  109. Matt Warfield, Barbara DiPietro, and Samantha Artiga, How has the ACA Medicaid Expansion Affected Providers Serving the Homeless Population: Analysis of Coverage, Revenues, and Costs (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, March 2016), https://files.kff.org/attachment/issue-brief-how-has-the-aca-medicaid-expansion-affected-providers-serving-the-homeless-population
  110. Robin Rudowitz, Samantha Artiga, Anthony Damico, and Rachel Garfield, A Closer Look at the Remaining Uninsured Population Eligible for Medicaid and CHIP (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, February 2016), http://kff.org/uninsured/issue-brief/a-closer-look-at-the-remaining-uninsured-population-eligible-for-medicaid-and-chip/
  111. Christopher Truffer, Christian Wolfe, and Kathryn Rennie, 2016 Actuarial Report on the Financial Outlook for Medicaid, (Office of the Actuary, Centers for Medicare and Medicaid Services, 2016), https://www.cms.gov/Research-Statistics-Data-and Systems/Research/ActuarialStudies/Downloads/MedicaidReport2016.pdf
  112. Robert Kaestner, Bowen Garrett, Anuj Gangopadhyaya, and Caitlyn Fleming, Effects of ACA Medicaid Expansions on Health Insurance Coverage and Labor Supply (Working Paper No. 21836, National Bureau of Economic Research, December 2015), http://www.nber.org/papers/w21836
  113. Robin Rudowitz, Laura Snyder, and Vernon Smith, Medicaid Enrollment and Spending Growth: FY 2015 & 2016 (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, October 2015), http://kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2015-2016/
  114. Jessica Smith and Carla Medalia, Health Insurance Coverage in the United States: 2014 (U.S. Census Bureau, September 2015), https://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-253.pdf
  115. Benjamin Sommers, Munira Gunja, Kenneth Finegold, and Thomas Musco, “Changes in Self-Reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act,” The Journal of the American Medical Association 314 no. 4 (July 2015): 366-374, http://jama.jamanetwork.com/article.aspx?articleid=2411283&resultClick=3
  116. Stacey McMorrow, Genevieve Kenney, Sharon Long, and Nathaniel Anderson, “Uninsurance Among Young Adults Continues to Decline, Particularly in Medicaid Expansion States,” Health Affairs 34, no. 4 (April 2015): 616-620, http://content.healthaffairs.org/content/34/4/616.full
  117. Sara Collins, Petra Rasmussen, Michelle Doty, and Sophie Beutel The Rise in Health Care Coverage and Affordability Since Health Reform Took Effect: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2014 (The Commonwealth Fund, January 2015), http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2015/jan/1800_collins_biennial_survey_brief.pdf?la=en
  118. Sharon Long, Michael Karpman, Adele Shartzer, Douglas Wissoker, Genevieve Kenney, Stephen Zuckerman, Nathaniel Anderson, and Katherine Hempstead, Taking Stock: Health Insurance Coverage under the ACA as of September 2014 (The Urban Institute, December 2014), http://hrms.urban.org/briefs/Health-Insurance-Coverage-under-the-ACA-as-of-September-2014.html
  119. Benjamin Sommers, Thomas Musco, Kenneth Finegold, Munira Gunja, Amy Burke, and Audrey McDowell, “Health Reform and Changes in Health Insurance Coverage in 2014” The New England Journal of Medicine 371 (August 2014): 867-874, http://www.nejm.org/doi/full/10.1056/NEJMsr1406753

MULTI-STATE STUDIES (back to top)

  1. Sarah H. Gordon, Benjamin D. Sommers, Ira B. Wilson, and Amal N. Trivedi, “Effects Of Medicaid Expansion On Postpartum Coverage And Outpatient Utilization,” Health Affairs 39, no. 1 (January 2020): 77-84, https://doi.org/10.1377/hlthaff.2019.00547
  2. John A. Graves et al., “Medicaid Expansion Slowed Rates of Health Decline for Low-Income Adults in Southern States,” Health Affairs 39, no. 1 (January 2020): 67-76, https://doi.org/10.1377/hlthaff.2019.00929
  3. Amandeep R. Mahal et al., “Early Impact of the Affordable Care Act and Medicaid Expansion on Racial and Socioeconomic Disparities in Cancer Care,” American Journal of Clinical Oncology Epub ahead of print (January 2020), https://doi.org/10.1097/coc.0000000000000588
  4. Shiho Kino and Ichiro Kawachi, “Can Health Literacy Boost Health Services Utilization in the Context of Expanded Access to Health Insurance?,” Health Education & Behavior Epub ahead of print (October 2019), https://doi.org/10.1177/1090198119875998
  5. Charles J. Courtemanche, James Marton, and Aaron Yelowitz, Medicaid Coverage across the Income Distribution under the Affordable Care Act (National Bureau of Economic Research, Working Paper No. 26145, August 2019), http://www.nber.org/papers/w26145
  6. Huabin Luo, Zhuo Chen, Lei Xu, and Ronny Bell, “Health Care Access and Receipt of Clinical Diabetes Preventive Care for Working-Age Adults With Diabetes in States With and Without Medicaid Expansion: Results from the 2013 and 2015 BRFSS,” Journal of Public Health Management and Practice 25, no. 4 (July/August 2019): 34-43, https://doi.org/10.1097/phh.0000000000000832
  7. Deborah Yip et al., “Association of Medicaid Expansion and Health Insurance with Receipt of Smoking Cessation Services and Smoking Behaviors in Substance Use Disorder Treatment,” The Journal of Behavioral Health Services & Research (July 2019), https://doi.org/10.1007/s11414-019-09669-1
  8. Sarah Gordon, Benjamin Sommers, Ira Wilson, Omar Galarraga, and Amal Trivedi, “The Impact of Medicaid Expansion on Continuous Enrollment: a Two State Analysis,” Journal of General Internal Medicine epub ahead of print (June 2019), https://link.springer.com/article/10.1007/s11606-019-05101-8
  9. Jose Mesquita-Neto, Peter Cmorej, Hassan Mouzaihem, Donald Weaver, Steve Kim, and Francis Macedo, “Disparities In Access To Cancer Surgery After Medicaid Expansion,” The American Journal of Surgery epub ahead of print (June 2019), https://www.sciencedirect.com/science/article/abs/pii/S0002961019306889
  10. Benjamin Sommers, Anna Goldman, Robert Blendon, E. John Orav, and Arnold Epstein, “Medicaid Work Requirements – Results from the First Year in Arkansas,” The New England Journal of Medicine Special Report (June 2019), https://www.nejm.org/doi/full/10.1056/NEJMsr1901772
  11. Vikki Wachino and Samantha Artiga, How Connecting Justice-Involved Individuals to Medicaid Can Help Address the Opioid Epidemic (Washington, DC: Kaiser Family Foundation, June 2019), https://www.kff.org/medicaid/issue-brief/how-connecting-justice-involved-individuals-to-medicaid-can-help-address-the-opioid-epidemic/
  12. Alina Denham and Peter Veazie, “Did Medicaid Expansion Matter in States with Generous Medicaid?” The American Journal of Managed Care 25, no. 3 (March 2019): 129-134, https://www.ajmc.com/journals/issue/2019/2019-vol25-n3/did-medicaid-expansion-matter-in-states-with-generous-medicaid
  13. Andrew Admon, Michael Sjoding, Sarah Lyon, John Ayanian, Theodore Iwashyna, and Colin Cooke, “Medicaid Expansion and Mechanical Ventilation in Asthma, Chronic Obstructive Pulmonary Disease, and Heart Failure,” Annals of the American Thoracic Society epub ahead of print (February 2019), https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201811-777OC
  14. Carrie Fry and Benjamin Sommers, “Effect of Medicaid Expansion on Health Insurance Coverage and Access to Care Among Adults With Depression,” Psychiatric Services 69, no. 11 (November 2018), https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800181
  15. Manzilat Akande, Peter Minneci, Katherine Deans, Henry Xiang, Deena Chisolm, and Jennifer Cooper, “Effects Of Medicaid Expansion On Disparities In Trauma Care And Outcomes In Young Adults,” Journal of Surgical Research 228 (August 2018): 42-53, https://www.sciencedirect.com/science/article/pii/S0022480418301562
  16. Xuesong Han, Robin Yabroff, Elizabeth Ward, Otis Brawley, and Ahmedin Jemal, “Comparison of Insurance Status and Diagnosis Stage Among Patients With Newly Diagnosed Cancer Before vs After Implementation of the Patient Protection and Affordable Care Act,” JAMA Oncology 4, no. 12 (August 2018): 1713-1720, https://jamanetwork.com/journals/jamaoncology/article-abstract/2697226
  17. Benjamin Sommers, Carrie Fry, Robert Blendon, and Arnold Epstein, “New Approaches in Medicaid: Work Requirements, Health Savings Accounts, and Health Care Access,” Health Affairs 37, no. 7 (June 2018), https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2018.0331
  18. Emily Zylla, Colin Planalp, Elizabeth Lukanen, and Lynn Blewett, Section 1115 Medicaid Expansion Waivers: Implementation Experiences, (Medicaid and CHIP Payment and Access Commission, February 2018), https://www.macpac.gov/publication/section-1115-medicaid-expansion-waivers-implementation-experiences/
  19. Fumiko Chino, Gita Suneja, Haley Moss, S. Yousuf Zafar, Laura Havrilesky, and Junzo Chino, “Healthcare Disparities in Cancer Patients Receiving Radiation: Changes in Insurance Status After Medicaid Expansion Under the Affordable Care Act,” International Journal of Radiation Oncology (December 2017), http://www.sciencedirect.com/science/article/pii/S0360301617341883
  20. Benjamin Sommers, Bethany Maylone, Robert Blendon, E. John Orav, and Arnold Epstein, “Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults,” Health Affairs epub ahead of print (May 2017), http://content.healthaffairs.org/content/early/2017/05/15/hlthaff.2017.0293
  21. MaryBeth Musumeci, Robin Rudowitz, Petry Ubri, and Elizabeth Hinton, An Early Look at Medicaid Expansion Waiver Implementation in Michigan and Indiana (Washington, DC: The Kaiser Family Foundation, January 2017), http://kff.org/medicaid/issue-brief/an-early-look-at-medicaid-expansion-waiver-implementation-in-michigan-and-indiana/
  22. Benjamin Sommers, Robert Blendon, E. John Orav, and Arnold Epstein, “Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance,” The Journal of the American Medical Association 176 no. 10 (October 2016): 1501-1509, http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2542420
  23. Benjamin Sommers, Rebecca Gourevitch, Bethany Maylone, Robert Blendon, and Arnold Epstein, “Insurance Churning Rates for Low-Income Adults Under Health Reform: Lower Than Expected but Still Harmful for Many,” Health Affairs 35 no. 10 (October 2016): 1816-1824, http://content.healthaffairs.org/content/35/10/1816.full?sid=f4835910-ffd0-4864-a76a-b4f207ccd018
  24. Stephen Berry et al., “Healthcare Coverage for HIV Provider Visits before and after Implementation of the Affordable Care Act,” Clinical Infectious Diseases, (May 2016), http://www.ncbi.nlm.nih.gov/pubmed/27143660
  25. Benjamin Sommers, Robert Blendon, and E. John Orav, “Both the ‘Private Option’ And Traditional Medicaid Expansions Improved Access To Care For Low-Income Adults,” Health Affairs 35, no. 1 (January 2016): 96-105, http://content.healthaffairs.org/content/35/1/96.abstract
  26. Michael Dworsky and Christine Eibner, The Effect of the 2014 Medicaid Expansion on Insurance Coverage for Newly Eligible Childless Adults (Santa Monica, CA: Rand Corporation, 2016), https://www.rand.org/pubs/research_reports/RR1736.html
  27. Samantha Artiga and Robin Rudowitz, How Have State Medicaid Expansion Decisions Affected the Experiences of Low-Income Adults? Perspectives from Ohio, Arkansas, and Missouri (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, June 2015), http://kff.org/medicaid/issue-brief/how-have-state-medicaid-expansion-decisions-affected-the-experiences-of-low-income-adults-perspectives-from-ohio-arkansas-and-missouri/
  28. Samantha Artiga, Jennifer Tolbert, and Robin Rudowitz, Year Two of the ACA Coverage Expansions: On-the-Ground Experiences from Five States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, June 2015), http://kff.org/health-reform/issue-brief/year-two-of-the-aca-coverage-expansions-on-the-ground-experiences-from-five-states/
  29. Stan Dorn, Norton Francis, Laura Snyder, and Robin Rudowitz, The Effects of the Medicaid Expansion on State Budgets: An Early Look in Select States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, March 2015), http://kff.org/medicaid/issue-brief/the-effects-of-the-medicaid-expansion-on-state-budgets-an-early-look-in-select-states/
  30. Barbara DiPietro, Samantha Artiga, and Alexandra Gates, Early Impacts of the Medicaid Expansion for the Homeless Population (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, November 2014), http://kff.org/uninsured/issue-brief/early-impacts-of-the-medicaid-expansion-for-the-homeless-population/

SINGLE STATE STUDIES (back to top)

  1. Nevada’s Medicaid Population, (Las Vegas, NV: The Guinn Center, September 2019), https://guinncenter.org/wp-content/uploads/2019/09/Guinn-Center-NV-Medicaid-Population-Characteristics-2019.pdf
  2. Dennis McCarty, Yifan Gu, John W. McIlveen, and Bonnie K. Lind, “Medicaid Expansion and Treatment for Opioid Use Disorders in Oregon: An Interrupted Time-Series Analysis,” Addiction Science & Clinical Practice 14 (August 2019), https://doi.org/10.1186/s13722-019-0160-6
  3. James A. Richardson, Jared J. Llorens, and Roy L. Heidelberg. Medicaid Expansion and the Louisiana Economy, 2018 and 2019 (Louisiana Department of Health, Prepared by Louisiana State University, August 2019), http://ldh.la.gov/assets/media/3and4.2019FinalReportMedicaidExpansionstudy.pdf
  4. MaryBeth Musumeci, Disability and Technical Issues Were Key Barriers to Meeting Arkansas’ Medicaid Work and Reporting Requirements in 2018 (Washington, DC: Kaiser Family Foundation, June 2019), https://www.kff.org/medicaid/issue-brief/disability-and-technical-issues-were-key-barriers-to-meeting-arkansas-medicaid-work-and-reporting-requirements-in-2018/
  5. Robin Rudowitz, MaryBeth Musumeci, and Cornelia Hall, February State Data for Medicaid Work Requirements in Arkansas (Washington, DC: Kaiser Family Foundation, March 2019), https://www.kff.org/medicaid/issue-brief/state-data-for-medicaid-work-requirements-in-arkansas/
  6. MaryBeth Musumeci, Robin Rudowitz, and Barbara Lyons, Medicaid Work Requirements in Arkansas: Experience and Perspectives of Enrollees (Washington, DC: Kaiser Family Foundation, December 2018), https://www.kff.org/medicaid/issue-brief/medicaid-work-requirements-in-arkansas-experience-and-perspectives-of-enrollees/
  7. MaryBeth Musumeci, Robin Rudowitz, and Cornelia Hall, An Early Look at Implementation of Medicaid Work Requirements in Arkansas (Washington, DC: Kaiser Family Foundation, October 2018), https://www.kff.org/medicaid/issue-brief/an-early-look-at-implementation-of-medicaid-work-requirements-in-arkansas/
  8. Stephen Barnes, Mike Henderson, Dek Terrell, and Stephanie Virgets, 2017 Louisiana Health Insurance Survey (Louisiana Department of Health, prepared by the Louisana State University E.J. Ourso College of Business, August 2018), http://ldh.la.gov/assets/media/2017-Louisiana-Health-Insurance-Survey-Report.pdf
  9. Seth Freedman, Lilliard Richardson, and Kosali Simon, “Learning From Waiver States: Coverage Effects Under Indiana’s HIP Medicaid Expansion,” Health Affairs 37, no. 6 (June 2018), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.1596
  10. Manatt Health, Medicaid Expansion: How It Affects Montana’s State Budget, Economy, and Residents (Montana Healthcare Foundation, prepared by Manatt Health, June 2018), https://mthcf.org/wp-content/uploads/2018/06/Manatt-MedEx_FINAL_6.1.18.pdf
  11. Louisiana Department of Health, Medicaid Expansion 2016/17 (Baton Rouge, Louisiana Department of Health, June 2017), http://dhh.louisiana.gov/assets/HealthyLa/Resources/MdcdExpnAnnlRprt_2017_WEB.pdf
  12. Eric Seiber and Micah Berman, “Medicaid Expansion and ACA Repeal: Evidence from Ohio,” American Journal of Public Health epub ahead of print (April 2017), http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2017.303722
  13. The Lewin Group, Healthy Indiana Plan 2.0: POWER Account Contribution Assessment, (The Lewin Group, prepared for the Indiana Family and Social Services Administration, March 2017), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/Healthy-Indiana-Plan-2/in-healthy-indiana-plan-support-20-POWER-acct-cont-assesmnt-03312017.pdf
  14. The Ohio Department of Medicaid, 2018 Ohio Medicaid Group VIII Assessment: A FollowUp to the 2016 Ohio Medicaid Group VIII Assessment, (The Ohio Department of Medicaid, August 2018), https://medicaid.ohio.gov/Portals/0/Resources/Reports/Annual/Group-VIII-Final-Report.pdf
  15. Pennsylvania Department of Human Services, Medicaid Expansion Report, (Pennsylvania Department of Human Services, January 2017), http://www.dhs.pa.gov/cs/groups/webcontent/documents/document/c_257436.pdf
  16. The Lewin Group, Indiana Healthy Indiana Plan 2.0: Interim Evaluation Report (The Lewin Group, Prepared for Indiana Family and Social Services Administration, July 2016), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/Healthy-Indiana-Plan-2/in-healthy-indiana-plan-support-20-interim-evl-rpt-07062016.pdf
  17. John Heintzman, Steffani Bailey, Jennifer DeVoe, Stuart Cowburn, Tanya Kapka, Truc-Vi Duong, and Miguel Marino, “In Low-Income Latino Patients, Post-Affordable Care Act Insurance Disparities May Be Reduced Even More than Broader National Estimates: Evidence from Oregon,” Journal of Racial and Ethnic Health Disparities (April 2016), http://www.ncbi.nlm.nih.gov/pubmed/27105630
  18. Joseph Benitez, Liza Creel, and J’Aime Jennings, “Kentucky’s Medicaid Expansion Showing Early Promise on Coverage and Access to Care,” Health Affairs (February 2016), http://content.healthaffairs.org/content/early/2016/02/16/hlthaff.2015.1294
  19. Arkansas Health Reform Legislative Task Force, Health Care Task Force Preliminary Report, (Arkansas Health Reform Legislative Task Force, December 2015), http://www.arkleg.state.ar.us/assembly/2015/Meeting%20Attachments/836/I14218/Task%20Force%20report%2012-17-15%20sent%20to%20Jill.pdf
  20. Jocelyn Guyer, Naomi Shine, MaryBeth Musumeci, and Robin Rudowitz, A Look at the Private Option in Arkansas (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, August 2015), http://kff.org/medicaid/issue-brief/a-look-at-the-private-option-in-arkansas/
  21. Michael McCue, “The Impact of Medicaid Expansion on Medicaid Focused Insurers in California,” Inquiry: The Journal of Health Care Organization, Provision, and Financing 52 (July 2015), http://inq.sagepub.com/content/52/0046958015595960.full.pdf+html
  22. Deloitte Development LLC, Commonwealth of Kentucky Medicaid Expansion Report, (Deloitte Development LLC, February 2015), http://jointhehealthjourney.com/images/uploads/channel-files/Kentucky_Medicaid_Expansion_One-Year_Study_FINAL.pdf

Impact of Expansion on Access to Care, Utilization, Affordability, and Health Outcomes

NATIONWIDE STUDIES (back to top)

  1. Jesse C. Baumgartner, Sara R. Collins, David C. Radley, and Susan L. Hayes, How the Affordable Care Act Has Narrowed Racial and Ethnic Disparities in Access to Health Care (The Commonwealth Fund, January 2020), https://www.commonwealthfund.org/publications/2020/jan/how-ACA-narrowed-racial-ethnic-disparities-access
  2. Anna L. Goldman and Benjamin D. Sommers, “Among Low-Income Adults Enrolled In Medicaid, Churning Decreased After The Affordable Care Act,” Health Affairs 39, no. 1 (January 2020): 85-93, https://doi.org/10.1377/hlthaff.2019.00378
  3. Nicole Kravitz-Wirtz et al., “Association of Medicaid Expansion With Opioid Overdose Mortality in the United States,” JAMA Network Open 3, no. 1 (January 2020), https://doi.org/10.1001/jamanetworkopen.2019.19066
  4. Helmneh M. Sineshaw et al., “Association of Medicaid Expansion Under the Affordable Care Act With Stage at Diagnosis and Time to Treatment Initiation for Patients With Head and Neck Squamous Cell Carcinoma,” JAMA Otolaryngology–Head & Neck Surgery Epub ahead of print (January 2020), https://doi.org/10.1001/jamaoto.2019.4310
  5. Jean M. Abraham, Anne B. Royalty, and Coleman Drake, “The Impact of Medicaid Expansion on Employer Provision of Health Insurance,” International Journal of Health Economics and Management 19, no. 3-4 (December 2019): 317-340, https://doi.org/10.1007/s10754-018-9256-x
  6. Susan L. Averett, Julie K. Smith, and Yang Wang, “Medicaid Expansion and Opioid Deaths,” Health Economics 28, no. 12 (December 2019): 1491-1496, https://doi.org/10.1002/hec.3945
  7. Thomas C. Buchmueller, Helen G. Levy, and Robert G. Valletta, Medicaid Expansion and the Unemployed (National Bureau of Economic Research, Working Paper No. 26553, December 2019), http://www.nber.org/papers/w26553
  8. Travis Donahoe et al., “The Affordable Care Act Medicaid Expansion and Smoking Cessation Among Low-Income Smokers,” American Journal of Preventive Medicine 57, no. 6 (December 2019): 203-210, https://doi.org/10.1016/j.amepre.2019.07.004
  9. Hiroshi Gotanda, Gerald Kominski, and Yusuke Tsugawa, “Association Between the ACA Medicaid Expansions and Primary Care and Emergency Department Use During the First 3 Years,” Journal of General Internal Medicine Epub ahead of print (December 2019), https://doi.org/10.1007/s11606-019-05458-w
  10. Kelsey L. Corrigan et al., “The Impact of the Patient Protection and Affordable Care Act on Insurance Coverage and Cancer-Directed Treatment in HIV-Infected Patients With Cancer in the United States,” Cancer (November 2019), https://doi.org/10.1002/cncr.32563
  11. Xuesong Han et al., “Changes in Noninsurance and Care Unaffordability Among Cancer Survivors Following the Affordable Care Act,” Journal of the National Cancer Institute Epub ahead of print (November 2019), https://doi.org/10.1093/jnci/djz218
  12. Claire E. Margerison et al., “Impacts of Medicaid Expansion on Health Among Women of Reproductive Age,” American Journal of Preventive Medicine Epub ahead of print (November 2019), https://doi.org/10.1016/j.amepre.2019.08.019
  13. James A. Swartz and Susanny J. Beltran, “Prescription Opioid Availability and Opioid Overdose-Related Mortality Rates in Medicaid Expansion and Non-Expansion States,” Addiction 114, no. 11 (November 2019): 2016-2025, https://doi.org/10.1111/add.14741
  14. Yunwei Gai and John Marthinsen, “Medicaid Expansion, HIV Testing, and HIV-Related Risk Behaviors in the United States, 2010-2017,” American Journal of Public Health 109, no. 10 (October 2019): 1404-1412, https://doi.org/10.2105/ajph.2019.305220
  15. Jin Huang and Shirley L. Porterfield, “Changes in Health Insurance Coverage and Health Care Access as Teens with Disabilities Transition to Adulthood,” Disability and Health Journal 12, no. 4 (October 2019): 551-556, https://doi.org/10.1016/j.dhjo.2019.06.009
  16. Jusung Lee et al., “The Impact of Medicaid Expansion on Diabetes Management,” Diabetes Care Epub ahead of print (October 2019), https://doi.org/10.2337/dc19-1173
  17. Johanna Catherine Maclean, Michael F. Pesko, and Steven C. Hill, “Public Insurance Expansions and Smoking Cessation Medications,” Economic Inquiry 57, no. 4 (October 2019): 1798-1820, https://doi.org/10.1111/ecin.12794
  18. Chelsea L. Shover et al., “The Relationship of Medicaid Expansion to Psychiatric Comorbidity Care within Substance Use Disorder Treatment Programs,” Journal of Substance Abuse Treatment 105 (October 2019): 44-50, https://doi.org/10.1016/j.jsat.2019.07.012
  19. Naomi Zewde, Erica Eliason, Heidi Allen, and Tal Gross, “The Effects of the ACA Medicaid Expansion on Nationwide Home Evictions and Eviction-Court Initiations: United States, 2000-2016,” American Journal of Public Health 109, no. 10 (October 2019): 1379-1383, https://doi.org/10.2105/ajph.2019.305230
  20. Evan M. Chen et al., “Association of the Affordable Care Act Medicaid Expansion with Dilated Eye Examinations among the United States Population with Diabetes,” Ophthalmology Epub ahead of print (September 2019), https://doi.org/10.1016/j.ophtha.2019.09.010
  21. Taressa K. Fraze et al., “Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals,” JAMA Network Open 2, no. 9 (September 2019), https://doi.org/10.1001/jamanetworkopen.2019.11514
  22. Gracie Himmelstein, “Effect of the Affordable Care Act’s Medicaid Expansions on Food Security, 2010-2016,” American Journal of Public Health 109, no. 9 (September 2019): 1243-1248, https://doi.org/10.2105/ajph.2019.305168
  23. Taylor Kelley, Renuka Tipirneni, and Helen Levy, “Changes in Veterans’ Coverage and Access to Care Following the Affordable Care Act, 2011-2017,” American Journal of Public Health 109, no. 9 (September 2019): 1233-1235, https://doi.org/10.2105/ajph.2019.305160
  24. Lindsay C. Kobayashi, Onur Altindag, Yulya Truskinovsky, and Lisa F. Berkman, “Effects of the Affordable Care Act Medicaid Expansion on Subjective Well-Being in the US Adult Population, 2010-2016,” American Journal of Public Health 109, no. 9 (September 2019): 1236-1242, https://doi.org/10.2105/ajph.2019.305164
  25. Sanders Korenman, Dahlia K. Remler, and Rosemary T. Hyson, “Medicaid Expansions and Poverty: Comparing Supplemental and Health-Inclusive Poverty Measures,” Social Service Review 93, no. 3 (September 2019): 429-483, https://doi.org/10.1086/705319
  26. Fredric Blavin, Impact of the Affordable Care Act’s Medicaid Expansion on Medicare Enrollees’ Access to Physician Services (Washington, DC: The Urban Institute, August 2019), https://www.urban.org/research/publication/effect-affordable-care-act-medicare-enrollees-access-physician-services
  27. Lisa Clemans-Cope, Victoria Lynch, Emma Winiski, and Marni Epstein, State Variation in Medicaid Prescriptions for Opioid Use Disorder from 2011 to 2018 (Washington, DC: The Urban Institute, August 2019), https://www.urban.org/research/publication/state-variation-medicaid-prescriptions-opioid-use-disorder-2011-2018
  28. Sri Lekha Tummalapalli, Samuel Leonard, Michelle M. Estrella, and Salomeh Keyhani, “The Effect of Medicaid Expansion on Self-Reported Kidney Disease,” Clinical Journal of American Society of Nephrology 14, no. 8 (August 2019): 1238-1240, https://doi.org/10.2215/cjn.02310219
  29. Kevin N. Griffith, “Changes in Insurance Coverage and Access to Care for Young Adults in 2017,” Journal of Adolescent Health Epub ahead of print (July 2019), https://doi.org/10.1016/j.jadohealth.2019.05.020
  30. Sameed Ahmed Khatana et al., “Association of Medicaid Expansion With Cardiovascular Mortality,” JAMA Cardiology 4, no. 7 (July 2019): 671-679, https://doi.org/10.1001/jamacardio.2019.1651
  31. Sarah Miller, Sean Altekruse, Norman Johnson, and Laura R. Wherry, Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data (National Bureau of Economic Research, Working Paper No. 26081, July 2019), http://www.nber.org/papers/w26081
  32. Ameen Barghi, Hugo Torres, Nancy Kressin, and Danny McCormick, “Coverage and Access for Americans with Cardiovascular Disease or Risk Factors After the ACA: a Quasi-experimental Study,” Journal of General Internal Medicine epub ahead of print (June 2019), https://link.springer.com/article/10.1007%2Fs11606-019-05108-1
  33. Nimish Valvi, Neomi Vin-Raviv, and Tomi Akinyemiju, “Current Smoking and Quit-Attempts Among US Adults Following Medicaid Expansion,” Preventive Medicine Reports epub ahead of print (June 2019), https://www.sciencedirect.com/science/article/pii/S2211335519300981
  34. Johanna Maclean and Brendan Saloner, “The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act,” Journal of Policy Analysis and Management 38, no. 2 (Spring 2019): 366-393, https://www.ncbi.nlm.nih.gov/pubmed/30882195
  35. Stacey Fedewa, K. Robin Yabroff, Robert Smith, Ann Goding Sauer, Xuesong Han, and Ahmedin Jemal, “Changes in Breast and Colorectal Cancer Screening After Medicaid Expansion Under the Affordable Care Act,” American Journal of Preventive Medicine epub ahead of print (May 2019), https://www.sciencedirect.com/science/article/pii/S0749379719301163
  36. Jevay Grooms and Alberto Ortega, “Examining Medicaid Expansion and the Treatment of Substance Use Disorders,” American Economic Association Papers and Proceedings 109 (May 2019): 187-192, https://www.aeaweb.org/articles?id=10.1257/pandp.20191090
  37. Nathalie Huguet et al., “Cervical And Colorectal Cancer Screening Prevalence Before And After Affordable Care Act Medicaid Expansion,” Preventative Medicine (May 2019), https://doi.org/10.1016/j.ypmed.2019.05.003
  38. Sarah Miller and Laura Wherry, “Four Years Later: Insurance Coverage and Access to Care Continue to Diverge between ACA Medicaid Expansion and Non-Expansion States,” American Economic Association Papers and Proceedings 109 (May 2019): 327-333, https://www.aeaweb.org/articles?id=10.1257/pandp.20191046
  39. Gary Pickens et al., “Changes In Hospital Service Demand, Cost, And Patient Illness Severity Following Health Reform,” Health Services Research (May 2019), https://doi.org/10.1111/1475-6773.13165
  40. Matthew Present, Aviva Nathan, Sandra Ham, Robert Sargis, Michael Quinn, and Elbert Huang, “The Impact of the Affordable Care Act Medicaid Expansion on Type 2 Diabetes Diagnosis and Treatment: A National Survey of Physicians,” Journal of Community Health epub ahead of print (May 2019), https://link.springer.com/article/10.1007%2Fs10900-019-00637-6
  41. Abeer Alharbi, M. Mahmud Khan, Ronnie Horner, Heather Brandt, and Cole Chapman, “Impact Of Medicaid Coverage Expansion Under The Affordable Care Act On Mammography And Pap Tests Utilization Among Low-Income Women,” PLOS One (April 2019), https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214886
  42. Christina Andrews et al., “Medicaid Coverage In Substance Use Disorder Treatment After The Affordable Care Act,” Journal of Substance Abuse Treatment epub ahead of print (April 2019), https://www.sciencedirect.com/science/article/pii/S0740547218305750
  43. Clare Brown et al., “Association of State Medicaid Expansion Status With Low Birth Weight and Preterm Birth” Journal of the American Medical Association 321, no. 16 (April 2019), https://jamanetwork.com/journals/jama/fullarticle/2731179
  44. Richard Frank and Carrie Fry, “The Impact of Expanded Medicaid Eligibility on Access To Naloxone,” Addiction epub ahead of print (April 2019), https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14634
  45. Ramin Mojtabai, Christine Mauro, Melanie Wall, Colleen Barry, and Mark Olfson, “The Affordable Care Act and Opioid Agonist Therapy for Opioid Use Disorder,” Psychiatry Online (April 2019), https://doi.org/10.1176/appi.ps.201900025
  46. Benjamin Cher, Nancy Morden, and Ellen Meara, “Medicaid Expansion and Prescription Trends: Opioids, Addiction Therapies, and Other Drugs,” Medical Care 57, no. 3 (March 2019): 208-212, https://journals.lww.com/lww-medicalcare/fulltext/2019/03000/Medicaid_Expansion_and_Prescription_Trends_.6.aspx
  47. Lisa Clemans-Cope, Marni Epstein, Victoria Lynch, and Emma Winiski, Rapid Growth in Medicaid Spending and Prescriptions to Treat Opioid Use Disorder and Opioid Overdose from 2010 to 2017 (Washington, DC: The Urban Institute, March 2019), https://www.urban.org/sites/default/files/publication/99798/rapid_growth_in_medicaid_spending_and_prescriptions_to_treat_opioid_use_disorder_and_opioid_overdose_from_2010_to_2017_2.pdf
  48. Robert Sandstrom, “Increased Utilization of Ambulatory Occupational Therapy and Physical Therapy After Medicaid Expansion” Archives of Physical Medicine and Rehabilitation epub ahead of print (March 2019), https://www.archives-pmr.org/article/S0003-9993(19)30161-3/fulltext
  49. Bernard Black, Alex Hollingsworth, Leticia Nunes, and Kosali Simon, The Effect of Health Insurance on Mortality: Power Analysis and What We Can Learn from the Affordable Care Act Coverage Expansions, (National Bureau of Economic Research, Working Paper Series No. 25568, February 2019), https://www.nber.org/papers/w25568
  50. Chad Cotti, Erik Nesson, and Nathan Tefft, “Impacts Of The ACA Medicaid Expansion On Health Behaviors: Evidence From Household Panel Data,” Health Economics 28, no. 2 (February 2019): 219-244, https://onlinelibrary.wiley.com/doi/pdf/10.1002/hec.3838
  51. J.W. Awori Hayanga et al., “Lung Transplantation and Affordable Care Act Medicaid Expansion in the Era of Lung Allocation Score” Transplant International epub ahead of print (February 2019), https://onlinelibrary.wiley.com/doi/pdf/10.1111/tri.13420
  52. Ausmita Ghosh, Kosali Simon, and Benjamin Sommers, “The Effect of Health Insurance on Prescription Drug Use Among Low-Income Adults: Evidence from Recent Medicaid Expansions,” Journal of Health Economics 63 (January 2019): 64-80, https://www.sciencedirect.com/science/article/pii/S0167629617300206
  53. De-Chih Lee, Leiyu Shi, and Hailun Liang, “Primary Care Utilization And Clinical Quality Performance: A Comparison Between Health Centres In Medicaid Expansion States And Non-Expansion States,” Journal of Health Services Research & Policy 24, no. 1 (January 2019): 19-24, https://journals.sagepub.com/doi/abs/10.1177/1355819618788592
  54. Helen Levy, Thomas Buchmueller, and Sayeh Nikpay, “The Impact of Medicaid Expansion on Household Consumption,” Eastern Economic Journal 45, no. 1 (January 2019): 34-57, https://link.springer.com/article/10.1057/s41302-018-0124-7
  55. Ramin Mojtabai, Christine Mauro, Melanie Wall, Colleen Barry, and Mark Olfson, “Medication Treatment For Opioid Use Disorders In Substance Use Treatment Facilities,” Health Affairs 38, no. 1 (January 2019), https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05162
  56. Rishi Wadhera et al., “Association of State Medicaid Expansion With Quality of Care and Outcomes for Low-Income Patients Hospitalized With Acute Myocardial Infarction,” JAMA Cardiology 4, no. 2 (January 2019): 120-127, https://jamanetwork.com/journals/jamacardiology/article-abstract/2720425?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamacardio.2018.4577
  57. Yasmin Zerhouni et al., “Effect of Medicaid Expansion on Colorectal Cancer Screening Rates,” Diseases of the Colon & Rectum 62, no. 1 (January 2019): 97-103, https://journals.lww.com/dcrjournal/Abstract/2019/01000/Effect_of_Medicaid_Expansion_on_Colorectal_Cancer.16.aspx
  58. Naomi Zewde and Christopher Wimer, “Antipoverty Impact Of Medicaid Growing With State Expansions Over Time,” Health Affairs 38, no. 1 (January 2019), https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05155
  59. Shiho Kino and Ichiro Kawachi, “The Impact Of ACA Medicaid Expansion On Socioeconomic Inequality In Health Care Services Utilization,” PLoS ONE 13, no. 2 (December 2018), https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209935
  60. Shailender Swaminathan, Benjamin Sommers, Rebecca Thorsness, Rajnish Mehrotra, Yoojin Lee, and Amal Trivedi, “Association of Medicaid Expansion With 1-Year Mortality Among Patients With End-Stage Renal Disease,” Journal of the American Medical Association (JAMA) 320, no. 21 (December 2018): 2242-2250, https://jamanetwork.com/journals/jama/fullarticle/2710505?guestAccessKey=ea3a8641-320b-4afd-b96e-dc59fbd90b20&utm_source=TrendMD&utm_medium=cpc&utm_campaign=J_Am_Med_TrendMD_1&utm_content=olf&utm_term=102518
  61. Michael Hendryx and Juhua Luo, “Increased Cancer Screening for Low-income Adults Under the Affordable Care Act Medicaid Expansion,” Medical Care 56, no. 11 (November 2018): 944-949, https://www.ingentaconnect.com/content/wk/mcar/2018/00000056/00000011/art00009
  62. Elham Mahmoudi, Alicia Cohen, Jason Buxbaum, Caroline Richardson, and Wassim Tarraf, “Gaining Medicaid Coverage During ACA Implementation: Effects on Access to Care and Preventive Services,” Journal of Health Care for the Poor and Underserved 29, no. 4 (November 2018): 1472-1487, https://muse.jhu.edu/article/708253
  63. Hyunjung Lee and Frank Porell, “The Effect of the Affordable Care Act Medicaid Expansion on Disparities in Access to Care and Health Status,” Medical Care Research and Review epub ahead of print (October 2018), https://journals.sagepub.com/doi/abs/10.1177/1077558718808709?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=mcrd
  64. Xuesong Han, Robin Yabroff, Elizabeth Ward, Otis Brawley, and Ahmedin Jemal, “Comparison of Insurance Status and Diagnosis Stage Among Patients With Newly Diagnosed Cancer Before vs After Implementation of the Patient Protection and Affordable Care Act,” JAMA Oncology 4, no. 12 (August 2018): 1713-1720, https://jamanetwork.com/journals/jamaoncology/article-abstract/2697226
  65. Rebecca Myerson, Tianyi Lu, Ivy Tonnu-Mihara, and Elbert Huang, “Medicaid Eligibility Expansions May Address Gaps In Access To Diabetes Medications,” Health Affairs 37, no. 8 (August 2018), https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0154
  66. Mark Olfson, Melanie Wall, Colleen Barry, Christine Mauro, and Ramin Mojtabai, “Impact Of Medicaid Expansion On Coverage And Treatment Of Low-Income Adults With Substance Use Disorders,” Health Affairs 37, no. 8 (August 2018), https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.0124
  67. Hannah Neprash, Anna Zink, Joshua Gray, and Katherine Hempstead, “Physicians’ Participation In Medicaid Increased Only Slightly Following Expansion” Health Affairs 37, no. 7 (July 2018), https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2017.1085
  68. Hilary Barnes, Michael Richards, Matthew McHugh, and Grant Martsolf, “Rural And Nonrural Primary Care Physician Practices Increasingly Rely On Nurse Practitioners,” Health Affairs 37, no. 6 (June 2018), https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2017.1158
  69. Megan Cole, Brad Wright, Ira Wilson, Omar Gallarraga, and Amal Trivedi, “Medicaid Expansion And Community Health Centers: Care Quality And Service Use Increased For Rural Patients” Health Affairs 37, no. 6 (June 2018), https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2017.1542
  70. Angelica Meinhofer and Allison Witman, “The Role Of Health Insurance On Treatment For Opioid Use Disorders: Evidence From The Affordable Care Act Medicaid Expansion,” Journal of Health Economics 60 (June 2018): 177-197, https://www.sciencedirect.com/science/article/abs/pii/S0167629617311530
  71. Rishi Wadhera et al., “Association of the Affordable Care Act’s Medicaid Expansion With Care Quality and Outcomes for Low-Income Patients Hospitalized With Heart Failure,” Circulation: Cardiovascular Quality and Outcomes 11, no. 7 (June 2018), https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.004729
  72. Alana Sharp, Austin Jones, Jennifer Sherwood, Oksana Kutsa, Brian Honermann, and Gregorio Millett, “Impact of Medicaid Expansion on Access to Opioid Analgesic Medications and Medication-Assisted Treatment,” American Journal of Public Health 108, no. 5 (May 2018): 642-648, https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2018.304338?journalCode=ajph
  73. Rachel Garfield, Elizabeth Hinton, Elizabeth Cornachione, and Cornelia Hall, Medicaid Managed Care Plans and Access to Care: Results from the Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/report/medicaid-managed-care-plans-and-access-to-care-results-from-the-kaiser-family-foundation-2017-survey-of-medicaid-managed-care-plans
  74. Sara Rosenbaum, Jennifer Tolbert, Jessica Sharac, Peter Shin, Rachel Gunsalus, and Julia Zur, Community Health Centers: Growing Importance in a Changing Health Care System (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/issue-brief/community-health-centers-growing-importance-in-a-changing-health-care-system/
  75. Nicolas Ajkay et al, “Early Impact of Medicaid Expansion and Quality of Breast Cancer Care in Kentucky,” Journal of the American College of Surgeons, epub ahead of print, February 2018, https://www.sciencedirect.com/science/article/pii/S107275151830022X
  76. Emily Johnston, Andrea Strahan, Peter Joski, Anne Dunlop, and E. Kathleen Adams, “Impacts of the Affordable Care Act’s Medicaid Expansion on Women of Reproductive Age,” Women’s Health Issues, 28, no. 2 (February 2018), http://www.whijournal.com/article/S1049-3867(17)30242-6/pdf
  77. Dahai Yue, Petra Rasmussen, and Ninez Ponce, “Racial/Ethnic Differential Effects of Medicaid Expansion on Health Care Access,” Health Services Research (February 2018), http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12834/abstract
  78. Chintan Bhatt and Consuelo Beck-Sague, “Medicaid Expansion and Infant Mortality in the United States,” American Journal of Public Health 108, no. 4 (April 2018): 565-567, https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.304218
  79. Frederic Blavin, Michael Karpman, Genevieve Kenney, and Benjamin Sommers, “Medicaid Versus Marketplace Coverage for Near-Poor Adults: Effects on Out-Of-Pocket Spending and Coverage,” Health Affairs 37 no. 2 (January 2018): 122-129 https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.1166
  80. Anna Goldman, Steffie Woolhandler, and David Himmelstein, “Out-of-pocket Spending and Premium Contributions After Implementation of the Affordable Care Act,” Journal of the American Medical Association epub ahead of print (January 2018), https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2669908
  81. Andrew Loehrer et al., “Association of the Affordable Care Act Medicaid Expansion with Access to and Quality of Care for Surgical Conditions,” Journal of the American Medical Association Surgery, epub ahead of print (January 2018), https://jamanetwork.com/journals/jamasurgery/article-abstract/2670459?redirect=true
  82. Susan Hayes, Sara Collins, David Radley, and Douglas McCarthy, What’s at Stake: States’ Progress on Health Coverage and Access to Care, 2013-2016 (The Commonwealth Fund, December 2017), http://www.commonwealthfund.org/publications/issue-briefs/2017/dec/states-progress-health-coverage-and-access
  83. Ahmedin Jemal, Chun Chieh Lin, Amy Davidoff, and Xuesong Han, “Changes in Insurance Coverage and Stage at Diagnosis Among Nonelderly Patients with Cancer after the Affordable Care Act,” Journal of Clinical Oncology 35, no. 35 (December 2017), http://ascopubs.org/doi/pdf/10.1200/JCO.2017.73.7817
  84. Thomas Selden, Brandy Lipton, and Sandra Decker, “Medicaid Expansion and Marketplace Eligibility Both Increased Coverage, With Trade-Offs in Access, Affordability,” Health Affairs 36 no. 12 (December 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0830
  85. Kenneth Brevoort, Daniel Grodzicki, and Martin Hackmann, Medicaid and Financial Health (National Bureau of Economic Research, Working Paper No. 24002, November 2017), http://www.nber.org/papers/w24002
  86. Tyler Winkelman and Virginia Chang, “Medicaid Expansion, Mental Health, and Access to Care Among Childless Adults With and Without Chronic Conditions,” Journal of General Internal Medicine epub ahead of print (November 2017), https://www.ncbi.nlm.nih.gov/pubmed/29181792
  87. Michael Dworsky, Carrie Farmer, and Mimi Shen, Veterans’ Health Insurance Coverage Under the Affordable Care Act and Implications of Repeal for the Department of Veterans Affairs, (RAND Corporation, 2017), https://www.rand.org/pubs/research_reports/RR1955.html
  88. Samantha Artiga, Barbara DiPietro, and Petry Ubri, The Role of Medicaid and the Impact of the Medicaid Expansion for Veterans Experiencing Homelessness, (Washington, DC: Kaiser Family Foundation, October 2017), https://www.kff.org/medicaid/issue-brief/the-role-of-medicaid-and-impact-of-the-medicaid-expansion-for-veterans-experiencing-homelessness/
  89. Kyle Caswell and Timothy Waidmann, The Affordable Care Act Medicaid Expansions and Personal Finance (Washington, DC: The Urban Institute, September 2017), https://www.urban.org/research/publication/affordable-care-act-medicaid-expansions-and-personal-finance
  90. Sunha Choi, Sungkyu Lee, and Jason Matejkowski, “The Effects of State Medicaid Expansion on Low-Income Individuals’ Access to Health Care: Multilevel Modeling,” Population Health Management epub ahead of print (September 2017), http://online.liebertpub.com/doi/abs/10.1089/pop.2017.0104
  91. Sharon Long, Lea Bart, Michael Karpman, Adele Shartzer, and Stephen Zuckerman, “Sustained Gains in Coverage, Access, and Affordability Under the ACA: A 2017 Update,” Health Affairs 36 no. 9 (September 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0798
  92. Haley Moss, Laura Havrilesky, and Junzo Chino, “Insurance Coverage Among Women Diagnosed with a Gynecologic Malignancy Before and After Implementation of the Affordable Care Act,” Gynecologic Oncology 146, no. 3 (September 2017), https://www.ncbi.nlm.nih.gov/pubmed/28641821
  93. Sherry Glied, Ougni Chakraborty, and Therese Russo, How Medicaid Expansion Affected Out-of-Pocket Health Care Spending for Low-Income Families (The Commonwealth Fund, August 2017), http://www.commonwealthfund.org/publications/issue-briefs/2017/aug/medicaid-expansion-out-of-pocket-spending-low-income
  94. Kevin Griffith, Leigh Evans, and Jacob Bor, “The Affordable Care Act Reduced Socioeconomic Disparities in Health Care Access,” Health Affairs 36 no. 8 (August 2017), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0083
  95. Susan Hayes, Pamela Riley, David Radley, and Douglas McCarthy, Reducing Racial and Ethnic Disparities in Access to Care: Has the Affordable Care Act Made a Difference? (The Commonwealth Fund, August 2017), http://www.commonwealthfund.org/publications/issue-briefs/2017/aug/racial-ethnic-disparities-care
  96. Dmitry Tumin et al., “Medicaid Participation among Liver Transplant Candidates after the Affordable Care Act Medicaid Expansion” Journal of the American College of Surgeons 225, no. 2 (August 2017): 173-180.e2, https://www.journalacs.org/article/S1072-7515(17)30454-4/fulltext
  97. Jacqueline Fiore, The Impact of the Affordable Care Act’s Medicaid Expansion on Medicaid Spending by Health Care Service Category (Tulane University, July 2017), http://econ.tulane.edu/RePEc/pdf/tul1706.pdf
  98. Aaron Sojourner and Ezra Golberstein, “Medicaid Expansion Reduced Unpaid Medical Debt and Increased Financial Satisfaction,” Health Affairs (July 2017), https://www.healthaffairs.org/do/10.1377/hblog20170724.061160/full/
  99. Lisa Clemans-Cope, Victoria Lynch, Marni Epstein, and Genevieve Kenney, Medicaid Coverage of Effective Treatment for Opioid Use Disorder, (Washington, DC: The Urban Institute, June 2017), https://www.urban.org/sites/default/files/publication/90461/2001287_medicaid_coverage_of_effective_treatment_for_opioid_use_disorder.pdf
  100. Joseph Labrum et al., “Does Medicaid Insurance Confer Adequate Access to Adult Orthopaedic Care in the Era of the Patient Protection and Affordable Care Act?” Clinical Orthopaedics and Related Research 475 no. 6 (June 2017): 1527-1536, https://link.springer.com/article/10.1007%2Fs11999-017-5263-3
  101. Gary Pickens et al., “Changes in Hospital Inpatient Utilization Following Health Care Reform,” Health Services Research epub ahead of print (June 2017), https://www.ncbi.nlm.nih.gov/pubmed/28664983
  102. Stacey McMorrow, Jason Gates, Sharon Long, and Genevieve Kenney, “Medicaid Expansion Increased Coverage, Improved Affordability, and Reduced Psychological Distress for Low-Income Parents,” Health Affairs 36 no. 5 (May 2017): 808-818, https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1650
  103. Brandy Lipton, Sandra Decker, and Benjamin Sommers, “The Affordable Care Act Appears to Have Narrowed Racial and Ethnic Disparities in Insurance Coverage and Access to Care Among Young Adults” Medical Care Research and Review 76, no.1 (April 2017): 32–55, https://www.ncbi.nlm.nih.gov/pubmed/29148341
  104. Johanna Maclean and Brendan Saloner, The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act (National Bureau of Economic Research Working Paper No. 23342, April 2017), http://www.nber.org/papers/w23342.pdf
  105. Astha Singhal, Peter Damiano, and Lindsay Sabik, “Medicaid Adult Dental Benefits Increase Use Of Dental Care, But Impact Of Expansion On Dental Services Use Was Mixed,” Health Affairs 36 no. 4 (April 2017): 723-732, http://content.healthaffairs.org/content/36/4/723.short
  106. Hefei Wen, Jason Hockenberry, Tyrone Borders, and Benjamin Druss, “Impact of Medicaid Expansion on Medicaid-covered Utilization of Buprenorphine for Opioid Use Disorder Treatment,” Medical Care 55 no. 4 (April 2017): 336-341, http://journals.lww.com/lww-medicalcare/Fulltext/2017/04000/Impact_of_Medicaid_Expansion_on_Medicaid_covered.5.aspx
  107. Charles Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata, Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health (National Bureau of Economic Research, Working Paper no. 23269, March 2017), http://www.nber.org/papers/w23269
  108. Sarah Miller and Laura Wherry, “Health and Access to Care During the First 2 Years of the ACA Medicaid Expansions,” The New England Journal of Medicine 376 no. 10 (March 2017), http://www.nejm.org/doi/full/10.1056/NEJMsa1612890
  109. Kosali Simon, Aparna Soni, and John Cawley, “The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions” Journal of Policy Analysis and Management 36, no. 2 (March 2017), https://onlinelibrary.wiley.com/doi/abs/10.1002/pam.21972
  110. Craig Garthwaite, Tal Gross, Matthew Notowidigdo, and John Graves, “Insurance Expansion and Hospital Emergency Department Access: Evidence from the Affordable Care Act,” Annals of Internal Medicine 166 no. 3 (February 2017): 172-179, http://annals.org/aim/article/2593599/insurance-expansion-hospital-emergency-department-access-evidence-from-affordable-care
  111. Khadijah Breathett et al., “The Affordable Care Act Medicaid Expansion Correlated with Increased Heart Transplant Listings in African Americans but Not Hispanics or Caucasians,” JACC: Heart Failure 5 no. 2 (January 2017): 136-147, https://www.ncbi.nlm.nih.gov/pubmed/28109783
  112. Megan Cole, Omar Galarraga, Ira Wilson, Brad Wright, and Amal Trivedi, “At Federally Funded Health Centers, Medicaid Expansion was Associated with Improved Quality of Care,” Health Affairs 36 no. 1 (January 2017): 40-48, http://content.healthaffairs.org/content/36/1/40.full?sid=a3089120-6f4b-428b-bba8-5f005b444e19
  113. Xinxin Han, Quian Luo, and Leighton Ku, “Medicaid Expansion and Grant Funding Increases Helped Improve Community Health Center Capacity,” Health Affairs 36 no. 1 (January 2017): 49-56, http://content.healthaffairs.org/content/36/1/49.full?sid=a3089120-6f4b-428b-bba8-5f005b444e19
  114. Ausmita Ghosh, Kosali Simon, and Benjamin Sommers, The Effect of State Medicaid Expansions on Prescription Drug Use: Evidence from the Affordable Care Act (Working Paper No. 23044, National Bureau of Economic Research, January 2017), http://www.nber.org/papers/w23044?utm_campaign=ntw&utm_medium=email&utm_source=ntw
  115. Anne DiGiulio et al., “State Medicaid Expansion Tobacco Cessation Coverage and Number of Adult Smokers Enrolled in Expansion Coverage – United States, 2016,” Morbidity and Mortality Weekly Report 65, no. 48 (December 2016), https://www.cdc.gov/mmwr/volumes/65/wr/mm6548a2.htm
  116. Kamyar Nasseh and Marko Vujicic, Early Impact of the Affordable Care Act’s Medicaid Expansion on Dental Care Use (Health Services Research, November 2016), http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12606/full
  117. James Kirby and Jessica Vistnes, “Access to Care Improved for People Who Gained Medicaid or Marketplace Coverage in 2014,” Health Affairs 35 no. 10 (October 2016): 1830-1834, http://content.healthaffairs.org/content/35/10/1830.full
  118. Jessica Vistnes and Joel Cohen, “Gaining Coverage in 2014: New Estimates of Marketplace and Medicaid Transitions,” Health Affairs 35 no. 10 (October 2016): 1825-1829, http://content.healthaffairs.org/content/35/10/1825.full?sid=cc385dd5-9c95-4ee1-9c58-888408d49c54
  119. Andrew Mulcahy, Christine Eibner, and Kenneth Finegold, “Gaining Coverage Through Medicaid Or Private Insurance Increased Prescription Use and Lowered Out-Of-Pocket Spending,” Health Affairs 35, no. 9 (September 2016), http://content.healthaffairs.org/content/early/2016/08/16/hlthaff.2016.0091.full
  120. Hefei Wen, Tyrone Borders, and Benjamin Druss, ”Number of Medicaid Prescriptions Grew, Drug Spending was Steady in Medicaid Expansion States,” Health Affairs 35, no. 12 (September 2016): 1604-1607, http://content.healthaffairs.org/content/35/9/1604.full
  121. Jesse M. Pines, Mark Zocchi, Ali Moghtaderi, Bernard Black, Steven A. Farmer, Greg Hufstetler, Kevin Klauer and Randy Pilgrim, “Medicaid Expansion In 2014 Did Not Increase Emergency Department Use But Did Change Insurance Payer Mix,” Health Affairs 35, no. 8 (August 2016), http://content.healthaffairs.org/content/35/8/1480.full
  122. Sara Collins, Munira Gunja, Michelle Doty, and Sophie Beutel, Americans’ Experiences with ACA Marketplace and Medicaid Coverage: Access to Care and Satisfaction (The Commonwealth Fund, May 2016), http://www.commonwealthfund.org/publications/issue-briefs/2016/may/aca-tracking-survey-access-to-care-and-satisfaction
  123. John Cawley, Aparna Soni, and Kosali Simon, “Third Year of Survey Data Shows Continuing Benefits of Medicaid Expansions for Low-Income Childless Adults in the U.S.,” Journal of General Internal Medicine 33, no. 9 (September 2018): 1495-1497, https://link.springer.com/article/10.1007%2Fs11606-018-4537-0
  124. Luojia Hu, Robert Kaestenr, Bhashkar Mazumder, Sarah Miller, and Ashley Wong, “The Effect of the Affordable Care Act Medicaid Expansions on Financial Wellbeing,” Journal of Public Economics 163 (July 2018): 99-112, https://www.sciencedirect.com/science/article/abs/pii/S0047272718300707
  125. Stacey McMorrow, Genevieve Kenney, Sharon Long, and Jason Gates, “Marketplaces Helped Drive Coverage Gains in 2015; Affordability Problems Remained,” Health Affairs 35 no. 10 (October 2016): 1810-1815, http://content.healthaffairs.org/content/35/10/1810.full
  126. Mary Anderson, Jeffrey Glasheen, Debra Anoff, “Impact of State Medicaid Expansion Status on Length of Stay and In-Hospital Mortality for General Medicine Patients at US Academic Medical Centers,” Journal of Hospital Medicine Epub ahead of print (August 2016), http://onlinelibrary.wiley.com/wol1/doi/10.1002/jhm.2649/citedby
  127. Laura Wherry and Sarah Miller, “Early Coverage, Access, Utilization, and Health Effects Associated with the Affordable Care Act Medicaid Expansions: A Quasi-experimental Study,” Annals of Internal Medicine, Epub ahead of print (April 2016), http://annals.org/article.aspx?articleid=2513980
  128. Josh Gray, Anna Zink, and Tony Dreyfus, Effects of the Affordable Care Act Through 2015, (athenaResearch and Robert Wood Johnson Foundation ACA View Report, March 2016), http://www.athenahealth.com/~/media/athenaweb/files/pdf/acaview_tracking_the_impact_of_health_care_reform
  129. Adele Shartzer, Sharon Long, and Nathaniel Anderson, “Access To Care and Affordability have Improved Following Affordable Care Act Implementation; Problems Remain,” Health Affairs (December 2015), http://content.healthaffairs.org/content/early/2015/12/14/hlthaff.2015.0755.full
  130. Peter Shin, Jessica Sharac, Julia Zur, Sara Rosenbaum, and Julia Paradise, Health Center Patient Trends, Enrollment Activities, and Service Capacity: Recent Experience in Medicaid Expansion and Non-Expansion States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, December 2015), http://kff.org/medicaid/issue-brief/health-center-patient-trends-enrollment-activities-and-service-capacity-recent-experience-in-medicaid-expansion-and-non-expansion-states/
  131. Benjamin Sommers, Munira Gunja, Kenneth Finegold, and Thomas Musco, “Changes in Self-Reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act,” The Journal of the American Medical Association 314 no. 4 (July 2015): 366-374, http://jama.jamanetwork.com/article.aspx?articleid=2411283&resultClick=3
  132. Harvey Kaufman, Zhen Chen, Vivian Fonseca, and Michael McPhaul, “Surge in Newly Identified Diabetes Among Medicaid Patients in 2014 Within Medicaid Expansion States Under the Affordable Care Act,” Diabetes Care 38, no. 5 (May 2015): 833, http://care.diabetesjournals.org/content/early/2015/03/19/dc14-2334.full.pdf+html
  133. IMS Institute for Healthcare Informatics, Medicines Use and Spending Shifts: A Review of the Use of Medicines in the US in 2014 IMS Institute for Healthcare Informatics, April 2015), http://www.imshealth.com/en/thought-leadership/ims-institute/reports/medicines-use-in-the-us-2014
  134. Josh Gray, Iyue Sung, and Stewart Richardson, Observations on the Affordable Care Act: 2014 (athenaResearch and Robert Wood Johnson Foundation ACA View Report, February 2015), http://www.athenahealth.com/~/media/athenaweb/files/pdf/acaview_year_end_2014.pdf

MULTI-STATE STUDIES (back to top)

  1. Emanuel Eguia et al., “The Impact of the Affordable Care Act Medicaid Expansion on Vascular Surgery,” Annals of Vascular Surgery Epub ahead of print (January 2020), https://doi.org/10.1016/j.avsg.2020.01.006
  2. Hawazin W. Elani, Ichiro Kawachi, and Benjamin D. Sommers, “Changes in Emergency Department Dental Visits after Medicaid Expansion,” Health Services Research Epub ahead of print (January 2020), https://doi.org/10.1111/1475-6773.13261
  3. Sarah H. Gordon, Benjamin D. Sommers, Ira B. Wilson, and Amal N. Trivedi, “Effects Of Medicaid Expansion On Postpartum Coverage And Outpatient Utilization,” Health Affairs 39, no. 1 (January 2020): 77-84, https://doi.org/10.1377/hlthaff.2019.00547
  4. John A. Graves et al., “Medicaid Expansion Slowed Rates of Health Decline for Low-Income Adults in Southern States,” Health Affairs 39, no. 1 (January 2020): 67-76, https://doi.org/10.1377/hlthaff.2019.00929
  5. Alexander T. Janke, Shooshan Danagoulian, Arjun K. Venkatesh, and Phillip D. Levy, “Medicaid Expansion and Resource Utilization in the Emergency Department,” The American Journal of Emergency Medicine Epub ahead of print (January 2020), https://doi.org/10.1016/j.ajem.2019.12.050
  6. Adam M. Almaguer et al., “Do Geographic Region, Medicaid Status, and Academic Affiliation Affect Access to Care Among Medicaid and Privately Insured Total Hip Arthroplasty Patients?,” Journal of Arthroplasty 34, no. 12 (December 2019): 2866-2871, https://doi.org/10.1016/j.arth.2019.07.030
  7. Mark Clapp et al., “Association of Medicaid Expansion With Coverage and Access to Care for Pregnant Women,” Obstetrics & Gynecology 134, no. 5 (November 2019): 1066-1074, https://doi.org/10.1097/aog.0000000000003501
  8. Afshin Ehsan et al., “Utilization of Left Ventricular Assist Devices in Vulnerable Adults Across Medicaid Expansion,” Journal of Surgical Research 243 (November 2019): 503-508, https://doi.org/10.1016/j.jss.2019.05.015
  9. Kelsie M. Gould et al., “Bariatric Surgery Among Vulnerable Populations: The Effect of the Affordable Care Act’s Medicaid Expansion,” Surgery 166, no. 5 (November 2019): 820-828, https://doi.org/10.1016/j.surg.2019.05.005
  10. Jesse M. Hinde et al., “Increasing Access to Opioid Use Disorder Treatment: Assessing State Policies and the Evidence Behind Them,” Journal of Studies on Alcohol and Drugs 80, no. 6 (November 2019): 693-697, https://doi.org/10.15288/jsad.2019.80.693
  11. Hefei Wen, Kenton J. Johnston, Lindsay Allen, and Teresa M. Waters, “Medicaid Expansion Associated With Reductions In Preventable Hospitalizations,” Health Affairs 38, no. 11 (November 2019): 1845-1849, https://doi.org/10.1377/hlthaff.2019.00483
  12. Mohammad Eslami et al., “Impact of Medicaid Expansion of the Affordable Care on the Outcomes of Lower Extremity Bypass for Patients With Peripheral Artery Disease in the Vascular Quality Initiative Database,” Annals of Surgery 270, no. 4 (October 2019): 647-655, https://doi.org/10.1097/sla.0000000000003521
  13. Shiho Kino and Ichiro Kawachi, “Can Health Literacy Boost Health Services Utilization in the Context of Expanded Access to Health Insurance?,” Health Education & Behavior Epub ahead of print (October 2019), https://doi.org/10.1177/1090198119875998
  14. Nadia Laniado, Avery R. Brow, Eric Tranby, and Victor M. Badner, “Trends in Non-Traumatic Dental Emergency Department Use in New York and New Jersey: A Look at Medicaid Expansion from Both Sides of the Hudson River,” Journal of Public Health Dentistry Epub ahead of print (October 2019), https://doi.org/10.1111/jphd.12343
  15. Elizabeth A. Brown et al., “The Impact of the ACA Medicaid Expansion on Access to Care and Hospitalization Charges for Lupus Patients,” Arthritis Care & Research Epub ahead of print (September 2019), https://doi.org/10.1002/acr.24080
  16. Craig Garthwaite et al., All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act (National Bureau of Economic Research, Working Paper No. 26289, September 2019), http://www.nber.org/papers/w26289
  17. Nathalie Huguet et al., “Following Uninsured Patients Through Medicaid Expansion: Ambulatory Care Use and Diagnosed Conditions,” Annals of Family Medicine 17, no. 4 (July/August 2019): 336-344, https://doi.org/10.1370/afm.2385
  18. Huabin Luo, Zhuo Chen, Lei Xu, and Ronny Bell, “Health Care Access and Receipt of Clinical Diabetes Preventive Care for Working-Age Adults With Diabetes in States With and Without Medicaid Expansion: Results from the 2013 and 2015 BRFSS,” Journal of Public Health Management and Practice 25, no. 4 (July/August 2019): 34-43, https://doi.org/10.1097/phh.0000000000000832
  19. Emanuel Eguia et al., “The Impact of the Affordable Care Act (ACA) Medicaid Expansion on Access to Minimally Invasive Surgical Care,” The American Journal of Surgery Epub ahead of print (July 2019), https://doi.org/10.1016/j.amjsurg.2019.07.003
  20. Deborah Yip et al., “Association of Medicaid Expansion and Health Insurance with Receipt of Smoking Cessation Services and Smoking Behaviors in Substance Use Disorder Treatment,” The Journal of Behavioral Health Services & Research (July 2019), https://doi.org/10.1007/s11414-019-09669-1
  21. Andrew Crocker et al., “Expansion Coverage And Preferential Utilization Of Cancer Surgery Among Racial And Ethnic Minorities And Low-Income Groups,” Surgery epub ahead of print (June 2019), https://www.surgjournal.com/article/S0039-6060(19)30198-9/fulltext
  22. Ramiro Manzano-Nunez et al., “Association of Medicaid Expansion Policy with Outcomes in Homeless Patients Requiring Emergency General Surgery,” World Journal of Surgery 43, no. 6 (June 2019): 1483-1489, https://link.springer.com/article/10.1007/s00268-019-04932-0
  23. Jose Mesquita-Neto, Peter Cmorej, Hassan Mouzaihem, Donald Weaver, Steve Kim, and Francis Macedo, “Disparities In Access To Cancer Surgery After Medicaid Expansion,” The American Journal of Surgery epub ahead of print (June 2019), https://www.sciencedirect.com/science/article/abs/pii/S0002961019306889
  24. Vikki Wachino and Samantha Artiga, How Connecting Justice-Involved Individuals to Medicaid Can Help Address the Opioid Epidemic (Washington, DC: Kaiser Family Foundation, June 2019), https://www.kff.org/medicaid/issue-brief/how-connecting-justice-involved-individuals-to-medicaid-can-help-address-the-opioid-epidemic/
  25. Hefei Wen, Adam S. Wilk, and Benjamin G. Druss, “Medicaid Acceptance by Psychiatrists Before and After Medicaid Expansion,” JAMA Psychiatry epub ahead of print (June 2019), https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2735109?resultClick=1
  26. Steffani Bailey et al., “Tobacco Cessation in Affordable Care Act Medicaid Expansion States Versus Non-expansion States,” Nicotine & Tobacco Research epub ahead of print (May 2019), https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntz087/5498071
  27. Rahul Ladhania, Amelia Haviland, Arvind Venkat, Rahul Telang, and Jesse Pines, “The Effect of Medicaid Expansion on the Nature of New Enrollees’ Emergency Department Use,” Medical Care Research and Review epub ahead of print (May 2019), https://journals.sagepub.com/doi/abs/10.1177/1077558719848270
  28. Andrew Admon, Thomas Valley, John Ayanian, Theodore Iwashyna, Colin Cooke, and Renuka Tipirneni, “Trends in Hospital Utilization After Medicaid Expansion,” Medical Care 57, no. 4 (April 2019): 312-317, https://journals.lww.com/lww-medicalcare/Abstract/publishahead/Brief_Report__Trends_in_Hospital_Utilization_After.98489.aspx
  29. Andrew Admon, Michael Sjoding, Sarah Lyon, John Ayanian, Theodore Iwashyna, and Colin Cooke, “Medicaid Expansion and Mechanical Ventilation in Asthma, Chronic Obstructive Pulmonary Disease, and Heart Failure,” Annals of the American Thoracic Society epub ahead of print (February 2019), https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201811-777OC
  30. Jenny Nguyen, Nidharshan Anandasivam, Daniel Cooperman, Richard Pelker, and Daniel Wiznia, “Does Medicaid Insurance Provide Sufficient Access to Pediatric Orthopedic Care Under the Affordable Care Act?,” Global Pediatric Health epub ahead of print (February 2019), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6381430/
  31. Jonathan Routh et al., “Early Impact of the Patient Protection and Affordable Care Act on Delivery of Children’s Surgical Care,” Clinical Pediatrics 58, no. 4 (January 2019) 453-460, https://journals.sagepub.com/doi/abs/10.1177/0009922818825156?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=cpja
  32. Cheryl Zogg et al., “Association of Medicaid Expansion With Access to Rehabilitative Care in Adult Trauma Patients,” JAMA Surgery epub ahead of print (January 2019), https://jamanetwork.com/journals/jamasurgery/article-abstract/2719270?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamasurg.2018.5177
  33. Cheryl Zogg et al., “Impact of Affordable Care Act Insurance Expansion on Pre-Hospital Access to Care: Changes in Adult Perforated Appendix Admission Rates after Medicaid Expansion and the Dependent Coverage Provision,” Journal of the American College of Surgeons 228, no. 1 (January 2019): 29-43, https://www.journalacs.org/article/S1072-7515(18)32078-7/fulltext
  34. Andrew Crocker et al., “The Affordable Care Act’s Medicaid Expansion And Utilization Of Discretionary Vs. Non-Discretionary Inpatient Surgery,” Surgery 164, no. 6 (December 2018): 1156-1161, https://www.sciencedirect.com/science/article/pii/S0039606018302186
  35. Carrie Fry and Benjamin Sommers, “Effect of Medicaid Expansion on Health Insurance Coverage and Access to Care Among Adults With Depression,” Psychiatric Services 69, no. 11 (November 2018), https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800181
  36. James McDermott et al., “Affordable Care Act’s Medicaid Expansion and Use of Regionalized Surgery at High-Volume Hospitals,” Journal of the American College of Surgeons 227, no. 5 (November 2018): 507-520.e9, https://www.journalacs.org/article/S1072-7515(18)31993-8/abstract
  37. Emanuel Eguia et al., “Impact of the Affordable Care Act (ACA) Medicaid Expansion on Cancer Admissions and Surgeries,” Annals of Surgery 268, no. 4 (October 2018): 584-590, https://journals.lww.com/annalsofsurgery/Abstract/2018/10000/Impact_of_the_Affordable_Care_Act__ACA__Medicaid.6.aspx
  38. Manzilat Akande Peter Minneci, Katherine Deans, Henry Xiang, and Jennifer Cooper, “Association of Medicaid Expansion Under the Affordable Care Act With Outcomes and Access to Rehabilitation in Young Adult Trauma Patients,” JAMA Surgery 153, no. 8 (August 2018), https://jamanetwork.com/journals/jamasurgery/article-abstract/2682872?widget=personalizedcontent&previousarticle=2719270
  39. Manzilat Akande, Peter Minneci, Katherine Deans, Henry Xiang, Deena Chisolm, and Jennifer Cooper, “Effects Of Medicaid Expansion On Disparities In Trauma Care And Outcomes In Young Adults,” Journal of Surgical Research 228 (August 2018): 42-53, https://www.sciencedirect.com/science/article/pii/S0022480418301562
  40. Ehimare Akhabue, Lindsay Pool, Clyde Yancy, Philip Greenland, and Donald Lloyd-Jones, “Association of State Medicaid Expansion With Rate of Uninsured Hospitalizations for Major Cardiovascular Events, 2009-2014,” JAMA Network Open 1, no. 4 (August 2018), https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2698077
  41. Brendan Saloner, Jonathan Levin, Hsien-Yen Chang, Christopher Jones, and G. Caleb Alexander, “Changes in Buprenorphine-Naloxone and Opioid Pain Reliever Prescriptions After the Affordable Care Act Medicaid Expansion,” JAMA Network Open 1, no. 4 (August 2018), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2696873
  42. Benjamin Sommers, Carrie Fry, Robert Blendon, and Arnold Epstein, “New Approaches in Medicaid: Work Requirements, Health Savings Accounts, and Health Care Access,” Health Affairs 37, no. 7 (June 2018), https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2018.0331
  43. Emily Zylla, Colin Planalp, Elizabeth Lukanen, and Lynn Blewett, Section 1115 Medicaid Expansion Waivers: Implementation Experiences (Medicaid and CHIP Payment and Access Commission, February 2018), https://www.macpac.gov/publication/section-1115-medicaid-expansion-waivers-implementation-experiences/
  44. Aparna Soni, Kosali Simon, John Cawley, and Lindsay Sabik, “Effect of Medicaid Expansions of 2014 on Overall and Early-Stage Cancer Diagnoses,” American Journal of Public Health epub ahead of print (December 2017), http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2017.304166
  45. Paul Jacobs, Genevieve Kenney, and Thomas Selden, “Newly Eligible Enrollees In Medicaid Spend Less And Use Less Care Than Those Previously Eligible,” Health Affairs 36, no. 9 (September 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0252
  46. Eric Charles et al., “Impact of Medicaid Expansion on Cardiac Surgery Volume and Outcomes,” The Annals of Thoracic Surgery (June 2017), http://www.annalsthoracicsurgery.org/article/S0003-4975(17)30552-0/pdf
  47. Jeremy Holzmacher et al., “Association of Expanded Medicaid Coverage with Hospital Length of Stay After Injury,” JAMA Surgery published online (June 2017), https://www.ncbi.nlm.nih.gov/pubmed/28658482
  48. United States Government Accountability Office (GAO), Medicaid Expansion: Behavioral Health Treatment Use in Selected States in 2014 (Washington, DC: GAO Report to Congressional Requesters, June 2017), https://www.gao.gov/assets/690/685415.pdf
  49. Nathalie Huguet et al., “Medicaid Expansion Produces Long-Term Impact on Insurance Coverage Rates in Community Health Centers,” Journal of Primary Care & Community Health epub ahead of print (May 2017), http://journals.sagepub.com/doi/full/10.1177/2150131917709403
  50. Benjamin Sommers, Bethany Maylone, Robert Blendon, E. John Orav, and Arnold Epstein, “Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults,” Health Affairs epub ahead of print (May 2017), http://content.healthaffairs.org/content/early/2017/05/15/hlthaff.2017.0293
  51. Molly Candon et al., Primary Care Appointment Availability and the ACA Insurance Expansions (Philadelphia, PA: University of Pennsylvania Leonard Davis Institute of Health Economics, March 2017), https://ldi.upenn.edu/brief/primary-care-appointment-availability-and-aca-insurance-expansions
  52. Nirosha Mahendraratnam, Stacie Dusetzina, and Joel Farley, “Prescription Drug Utilization and Reimbursement Increased Following State Medicaid Expansion in 2014,” Journal of Managed Care & Specialty Pharmacy 23 no. 3 (March 2017): 355-363, http://www.jmcp.org/doi/10.18553/jmcp.2017.23.3.355
  53. MaryBeth Musumeci, Robin Rudowitz, Petry Ubri, and Elizabeth Hinton, An Early Look at Medicaid Expansion Waiver Implementation in Michigan and Indiana (Washington, DC: The Kaiser Family Foundation, January 2017), http://kff.org/medicaid/issue-brief/an-early-look-at-medicaid-expansion-waiver-implementation-in-michigan-and-indiana/
  54. Megan Hoopes, Heather Angier, Rachel Gold, Steffani Bailey, Nathalie Huguet, Miguel Marino, and Jennifer DeVoe, “Utilization of Community Health Centers in Medicaid Expansion and Nonexpansion States, 2013-2014,” Journal of Ambulatory Care Management 39 no. 4 (October 2016): 290-298, https://www.ncbi.nlm.nih.gov/pubmed/26765808
  55. Benjamin Sommers, Robert Blendon, E. John Orav, Arnold Epstein, “Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance,” The Journal of the American Medical Association 176 no. 10 (October 2016): 1501-1509, http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2542420
  56. Samantha Artiga, Robin Rudowitz, Jennifer Tolbert, Julia Paradise, and Melissa Majerol, Findings from the Field: Medicaid Delivery Systems and Access to Care in Four States in Year Three of the ACA (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, September 2016), http://kff.org/medicaid/issue-brief/findings-from-the-field-medicaid-delivery-systems-and-access-to-care-in-four-states-in-year-three-of-the-aca/
  57. Simon Basseyn, Brendan Saloner, Genevieve Kenney, Douglas Wissoker, Daniel Polsky, and Karin Rhodes, Primary Care Appointment Availability for Medicaid Patients: Comparing Traditional and Premium Assistance Plans, (Penn Leonard Davis Institute of Health Economics, July 2016), http://ldi.upenn.edu/brief/primary-care-appointment-availability-medicaid-patients-comparing-traditional-and-premium
  58. Jane Wishner, Patricia Solleveld, Robin Rudowitz, Julia Paradise, and Larisa Antonisse, A Look at Rural Hospital Closures and Implications for Access to Care: Three Case Studies (Washington, DC: Kaiser Commission on Medicaid and the Uninsured and The Urban Institute, July 2016), http://kff.org/medicaid/issue-brief/a-look-at-rural-hospital-closures-and-implications-for-access-to-care/
  59. Benjamin Sommers, Robert Blendon, and E. John Orav, “Both the ‘Private Option’ And Traditional Medicaid Expansions Improved Access To Care For Low-Income Adults,” Health Affairs 35, no. 1 (January 2016): 96-105, http://content.healthaffairs.org/content/35/1/96.abstract
  60. Samantha Artiga and Robin Rudowitz, How Have State Medicaid Expansion Decisions Affected the Experiences of Low-Income Adults? Perspectives from Ohio, Arkansas, and Missouri (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, June 2015), http://kff.org/medicaid/issue-brief/how-have-state-medicaid-expansion-decisions-affected-the-experiences-of-low-income-adults-perspectives-from-ohio-arkansas-and-missouri/
  61. Samantha Artiga, Jennifer Tolbert, and Robin Rudowitz, Year Two of the ACA Coverage Expansions: On-the-Ground Experiences from Five States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, June 2015), http://kff.org/health-reform/issue-brief/year-two-of-the-aca-coverage-expansions-on-the-ground-experiences-from-five-states/
  62. Government Accountability Office, Behavioral Health: Options for Low-Income Adults to Receive Treatment in Selected States (Washington, DC: Government Accountability Office, June 2015), http://www.gao.gov/assets/680/670894.pdf
  63. Barbara DiPietro, Samantha Artiga, and Alexandra Gates, Early Impacts of the Medicaid Expansion for the Homeless Population (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, November 2014), http://kff.org/uninsured/issue-brief/early-impacts-of-the-medicaid-expansion-for-the-homeless-population/

SINGLE STATE STUDIES (back to top)

  1. Susan Dorr Goold et al., “Primary Care, Health Promotion, and Disease Prevention with Michigan Medicaid Expansion,” Journal of General Internal Medicine Epub ahead of print (December 2019), https://doi.org/10.1007/s11606-019-05370-3
  2. Susannah Gibbs et al., “Evaluating the Effect of Medicaid Expansion on Access to Preventive Reproductive Care for Women in Oregon,” Preventive Medicine Epub ahead of print (November 2019), https://doi.org/10.1016/j.ypmed.2019.105899
  3. Ann-Marie Rosland et al., “Diagnosis and Care of Chronic Health Conditions Among Medicaid Expansion Enrollees: a Mixed-Methods Observational Study,” Journal of General Internal Medicine 34, no. 11 (November 2019): 2549-2558, https://doi.org/10.1007/s11606-019-05323-w
  4. Heather Holderness et al., “Where Do Oregon Medicaid Enrollees Seek Outpatient Care Post-Affordable Care Act Medicaid Expansion?,” Medical Care 57, no. 10 (October 2019): 788-794, https://doi.org/10.1097/mlr.0000000000001189
  5. Charles A. Daly et al., “The Effects of Medicaid Expansion on Triage and Regional Transfer After Upper-Extremity Trauma,” The Journal of Hand Surgery 44, no. 9 (September 2019): 720-727, https://doi.org/10.1016/j.jhsa.2019.05.020
  6. John Scott et al., “Lifting the Burden: State Medicaid Expansion Reduces Financial Risk for the Injured,” Journal of Trauma and Acute Care Surgery Epub ahead of print (September 2019), https://doi.org/10.1097/ta.0000000000002493
  7. Renuka Tipirneni et al., “Association of Expanded Medicaid Coverage With Health and Job-Related Outcomes Among Enrollees With Behavioral Health Disorders,” Psychiatric Services Epub ahead of print (September 2019), https://doi.org/10.1176/appi.ps.201900179
  8. Dennis McCarty, Yifan Gu, John W. McIlveen, and Bonnie K. Lind, “Medicaid Expansion and Treatment for Opioid Use Disorders in Oregon: An Interrupted Time-Series Analysis,” Addiction Science & Clinical Practice 14 (August 2019), https://doi.org/10.1186/s13722-019-0160-6
  9. Mark L. Diana et al. Louisiana Medicaid Expansion and Access to Care (Louisiana Department of Health, Prepared by Tulane University, July 2019), http://ldh.la.gov/assets/media/AccesstoCareReport20132018final.pdf
  10. Tong Gan et al., “Impact of the Affordable Care Act on Colorectal Cancer Screening, Incidence, and Survival in Kentucky,” Journal of the American College of Surgeons 228, no. 4 (April 2019): 342-353.e1, https://www.journalacs.org/article/S1072-7515(19)30046-8/fulltext
  11. Brendan Saloner, Rachel Landis, Bradley Stein, and Colleen Barry, “The Affordable Care Act in the Heart of the Opioid Crisis: Evidence from West Virginia,” Health Affairs 38, no. 4 (April 2019), https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05049
  12. Renuka Tipirneni et al., “Changes in Health and Ability to Work Among Medicaid Expansion Enrollees: a Mixed Methods Study,” Journal of General Internal Medicine 34, no. 2 (February 2019): 272-280, https://link.springer.com/article/10.1007/s11606-018-4736-8
  13. Neal Bhutiani, Brian Harbrecht, Charles Scoggins, and Matthew Bozeman, “Evaluating The Early Impact Of Medicaid Expansion On Trends In Diagnosis And Treatment Of Benign Gallbladder Disease In Kentucky,” The American Journal of Surgery (January 2019), https://www.americanjournalofsurgery.com/article/S0002-9610(18)30894-8/fulltext
  14. Mark Duggan, Atul Gupta, and Emilie Jackson, The Impact of the Affordable Care Act: Evidence from California’s Hospital Sector (National Bureau of Economic Research, working paper no. 25488, January 2019), https://www.nber.org/papers/w25488.pdf
  15. Sarah Miller, Luojia Hu, Robert Kaestner, Bhashkar Mazumder, and Ashley Wong, The ACA Medicaid Expansion in Michigan and Financial Health, (National Bureau of Economic Research, working paper no. 25053, September 2018), https://www.nber.org/papers/w25053.pdf
  16. Michelle Moniz et al., “Association of Access to Family Planning Services With Medicaid Expansion Among Female Enrollees in Michigan,” JAMA Network Open 1, no. 4 (August 2018), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2698636
  17. The Ohio Department of Medicaid, 2018 Ohio Medicaid Group VIII Assessment: A FollowUp to the 2016 Ohio Medicaid Group VIII Assessment, (The Ohio Department of Medicaid, August 2018), https://medicaid.ohio.gov/Portals/0/Resources/Reports/Annual/Group-VIII-Final-Report.pdf
  18. Susan Dorr Goold et al., “Primary Care Clinicians’ Views About the Impact of Medicaid Expansion in Michigan: A Mixed Methods Study,” Journal of General Internal Medicine 33, no. 8 (June 2018): 1307-1316, https://link.springer.com/article/10.1007/s11606-018-4487-6
  19. Manatt Health, Medicaid Expansion: How It Affects Montana’s State Budget, Economy, and Residents, (Manatt Health, prepared for the Montana Healthcare Foundation, June 2018), https://mthcf.org/wp-content/uploads/2018/06/Manatt-MedEx_FINAL_6.1.18.pdf
  20. Shannon McConville, Maria Raven, Sarah Sabbagh, and Renee Hsia, “Frequent Emergency Department Users: A Statewide Comparison Before And After Affordable Care Act Implementation,” Health Affairs 37, no. 6 (June 2018), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0784
  21. Donald Likosky, Devraj Sukul, Milan Seth, Chang He, Hitlander Gurm, and Richard Prager, “The Association Between Medicaid Expansion and Cardiovascular Interventions: The Michigan Experience,” Journal of the American College of Cardiology 71, no. 9 (March 2018): 1050-1051, https://www.sciencedirect.com/science/article/pii/S0735109718300056?via%3Dihub
  22. Brad Wright et al., “Completion of Requirements in Iowa’s Medicaid Expansion Premium Disincentive Program, 2014–2015,” American Journal of Public Health 108, no. 2 (February 2018): 219-223, http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.304178
  23. Eili Klein et al., “The Effect of Medicaid Expansion on Utilization in Maryland Emergency Departments,” Annals of Emergency Medicine epub ahead of print (June 2017), http://www.annemergmed.com/article/S0196-0644(17)30784-9/pdf
  24. Louisiana Department of Health, Medicaid Expansion 2016/17 (Baton Rouge, Louisiana Department of Health, June 2017), http://dhh.louisiana.gov/assets/HealthyLa/Resources/MdcdExpnAnnlRprt_2017_WEB.pdf
  25. Aabha Sharma, Scott Dresden, Emilie Powell, Raymond Kang, Joe Feinglass, “Emergency Department Visits and Hospitalizations for the Uninsured in Illinois Before and After Affordable Care Act Insurance Expansion,” Journal of Community Health 42 no. 3 (June 2017): 591-597, https://link.springer.com/article/10.1007/s10900-016-0293-4
  26. Natoshia Askelson, Brad Wright, Suzanne Bentler, Elizabeth Momany, and Peter Damiano, “Iowa’s Medicaid Expansion Promoted Healthy Behaviors But Was Challenging to Implement and Attracted Few Participants,” Health Affairs 36 no. 5, (May 2017): 799-807, http://content.healthaffairs.org/content/36/5/799.full
  27. Angela Fertig, Caroline Carlin, Scote Ode, and Sharon Long, “Evidence of Pent-Up Demand for Care After Medicaid Expansion,” Medical Care Research and Review epub ahead of print (March 2017), http://journals.sagepub.com/eprint/wDsfA74fuA3BIw5ZWyYT/full
  28. The Lewin Group, Healthy Indiana Plan 2.0: POWER Account Contribution Assessment, (The Lewin Group, prepared for the Indiana Family and Social Services Administration, March 2017), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/Healthy-Indiana-Plan-2/in-healthy-indiana-plan-support-20-POWER-acct-cont-assesmnt-03312017.pdf
  29. Daniel Gingold, Rachelle Pierre-Mathieu, Brandon Cole, Andrew Miller, and Joneigh Khaldun, “Impact of the Affordable Care Act Medicaid Expansion on Emergency Department High Utilizers with Ambulatory Care Sensitive Conditions: A Cross-Sectional Study,” The American Journal of Emergency Medicine (January 2017), http://www.sciencedirect.com/science/article/pii/S0735675717300141
  30. Pennsylvania Department of Human Services, Medicaid Expansion Report, (Pennsylvania Department of Human Services, January 2017), http://www.dhs.pa.gov/cs/groups/webcontent/documents/document/c_257436.pdf
  31. Natalia Chalmers, Jane Grover, and Rob Compton, “After Medicaid Expansion in Kentucky, Use of Hospital Emergency Departments for Dental Conditions Increased,” Health Affairs 35, no. 12 (December 2016), http://content.healthaffairs.org/content/35/12/2268.full#xref-ref-32-1
  32. Jeffrey Horn et al., “New Medicaid Enrollees See Health and Social Benefits in Pennsylvania’s Expansion,” INQUIRY: the Journal of Health Care Organization, Provision, and Financing 53 (October 2016): 1-8, http://journals.sagepub.com/doi/full/10.1177/0046958016671807#
  33. The Lewin Group, Indiana Healthy Indiana Plan 2.0: Interim Evaluation Report (The Lewin Group, Prepared for Indiana Family and Social Services Administration, July 2016), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/Healthy-Indiana-Plan-2/in-healthy-indiana-plan-support-20-interim-evl-rpt-07062016.pdf
  34. Renuka Tipirneni et al., “Primary Care Appointment Availability and Nonphysician Providers One Year After Medicaid Expansion,” The American Journal of Managed Care 22 no. 6 (June 2016): 427-431, http://www.ajmc.com/journals/issue/2016/2016-vol22-n6/primary-care-appointment-availability-and-nonphysician-providers-one-year-after-medicaid-expansion
  35. Joseph Benitez, Liza Creel, and J’Aime Jennings, “Kentucky’s Medicaid Expansion Showing Early Promise on Coverage and Access to Care,” Health Affairs (February 2016), http://content.healthaffairs.org/content/early/2016/02/16/hlthaff.2015.1294
  36. Arkansas Health Reform Legislative Task Force, Health Care Task Force Preliminary Report, (Arkansas Health Reform Legislative Task Force, December 2015), http://www.arkleg.state.ar.us/assembly/2015/Meeting%20Attachments/836/I14218/Task%20Force%20report%2012-17-15%20sent%20to%20Jill.pdf
  37. Michael McCue, “The Impact of Medicaid Expansion on Medicaid Focused Insurers in California,” Inquiry: The Journal of Health Care Organization, Provision, and Financing 52 (July 2015), http://inq.sagepub.com/content/52/0046958015595960.full.pdf+html
  38. Renuka Tipirneni et al., “Primary Care Appointment Availability For New Medicaid Patients Increased After Medicaid Expansion In Michigan,” Health Affairs (July 2015), http://content.healthaffairs.org/content/early/2015/07/15/hlthaff.2014.1425.full
  39. Deloitte Development LLC, Commonwealth of Kentucky Medicaid Expansion Report, (Deloitte Development LLC, February 2015), http://jointhehealthjourney.com/images/uploads/channel-files/Kentucky_Medicaid_Expansion_One-Year_Study_FINAL.pdf

Economic Effects of Expansion

Impact on State Budgets and Economies

NATIONWIDE STUDIES (back to top)

  1. Qiwei He and Scott Barkowski, “The Effect of Health Insurance on Crime: Evidence from the Affordable Care Act Medicaid Expansion,” Health Economics Epub ahead of print (January 2020): 261-277, https://doi.org/10.1002/hec.3977
  2. Robin Rudowitz et al., Medicaid Enrollment and Spending Growth: FY 2019 & 2020 (Washington, DC: Kaiser Family Foundation, October 2019), https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2019-2020/
  3. Johanna Maclean and Brendan Saloner, “The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act,” Journal of Policy Analysis and Management 38, no. 2 (Spring 2019): 366-393, https://www.ncbi.nlm.nih.gov/pubmed/30882195
  4. Amanda Abraham et al., “Changes in State Technical Assistance Priorities and Block Grant Funds for Addiction After ACA Implementation,” American Journal of Public Health epub ahead of print (May 2019), https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2019.305052
  5. Gary Pickens et al., “Changes In Hospital Service Demand, Cost, And Patient Illness Severity Following Health Reform,” Health Services Research (May 2019), https://doi.org/10.1111/1475-6773.13165
  6. Robin Rudowitz, Elizabeth Hinton, and Larisa Antonisse, Medicaid Enrollment and Spending Growth: FY 2018 & 2019 (Washington, DC: Kaiser Family Foundation, October 2018), https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2018-2019/
  7. Christian Wolfe, Kathryn Rennie, and Christopher Truffer, 2017 Actuarial Report on the Financial Outlook for Medicaid (Office of the Actuary, Centers for Medicare and Medicaid Services, September 2018), https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/MedicaidReport2017.pdf
  8. Aditi Sen and Thomas DeLeire, “How Does Expansion Of Public Health Insurance Affect Risk Pools And Premiums In The Market For Private Health Insurance? Evidence From Medicaid And The Affordable Care Act Marketplaces,” Health Economics 27 (July 2018): 1877–1903, https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.3809
  9. Micah Hartman et al., “National Health Care Spending in 2016: Spending and Enrollment Growth Slow After Initial Coverage Expansions,” Health Affairs epub ahead of print (December 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.1299
  10. Aparna Soni, Marguerite Burns, Laura Dague, and Kosali Simon, “Medicaid Expansion and State Trends in Supplemental Security Income Program Participation,” Health Affairs 36 no. 8, (August 2017): 1485-1488, http://content.healthaffairs.org/content/36/8/1485.full?sid=982b20c0-0a17-4dc4-a35a-b0302d4ec289
  11. Seth Freedman, Sayeh Nikpay, Aaron Carroll, and Kosali Simon, “Changes in inpatient payer-mix and hospitalizations following Medicaid expansion: Evidence from all-capture hospital discharge data,” PLoS One 12 no. 9 (September 2017), http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0183616
  12. Jacqueline Fiore, The Impact of the Affordable Care Act’s Medicaid Expansion on Medicaid Spending by Health Care Service Category (Tulane University, July 2017), http://econ.tulane.edu/RePEc/pdf/tul1706.pdf
  13. David Lassman et al., “Health Spending by State 1991-2014: Measuring Per Capita Spending by Payers and Programs,” Health Affairs epub ahead of print (June 2017), http://content.healthaffairs.org/content/early/2017/06/13/hlthaff.2017.0416
  14. Benjamin Sommers and Jonathan Gruber, “Federal Funding Insulated State Budgets From Increased Spending Related To Medicaid Expansion,” Health Affairs epub ahead of print (April 2017), http://content.healthaffairs.org/content/early/2017/04/10/hlthaff.2016.1666.full
  15. Ashley Semanskee, Cynthia Cox, and Larry Levitt, Data Note: Effect of State Decisions on State Risk Scores (Kaiser Family Foundation, October 2016), https://www.kff.org/health-reform/issue-brief/data-note-effect-of-state-decisions-on-state-risk-scores/
  16. Aditi Sen and Thomas DeLeire, The Effect of Medicaid Expansion on Marketplace Premiums (Office of the Assistant Secretary for Planning and Evaluation, August 2016), https://aspe.hhs.gov/sites/default/files/pdf/206761/McaidExpMktplcPrem.pdf
  17. Laura Snyder, Katherine Young, Robin Rudowitz, and Rachel Garfield, Medicaid Expansion Spending and Enrollment in Context: An Early Look at CMS Claims Data for 2014 (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, January 2016), http://kff.org/medicaid/issue-brief/medicaid-expansion-spending-and-enrollment-in-context-an-early-look-at-cms-claims-data-for-2014/
  18. Christopher Truffer, Christian Wolfe, and Kathryn Rennie, 2016 Actuarial Report on the Financial Outlook for Medicaid, (Office of the Actuary, Centers for Medicare and Medicaid Services, 2016), https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/MedicaidReport2016.pdf
  19. Robin Rudowitz, Laura Snyder, and Vernon Smith, Medicaid Enrollment and Spending Growth: FY 2015 & 2016 (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, October 2015), http://kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2015-2016/

MULTI-STATE STUDIES (back to top)

  1. Jesse M. Hinde et al., “Increasing Access to Opioid Use Disorder Treatment: Assessing State Policies and the Evidence Behind Them,” Journal of Studies on Alcohol and Drugs 80, no. 6 (November 2019): 693-697, https://doi.org/10.15288/jsad.2019.80.693
  2. Vikki Wachino and Samantha Artiga, How Connecting Justice-Involved Individuals to Medicaid Can Help Address the Opioid Epidemic (Washington, DC: Kaiser Family Foundation, June 2019), https://www.kff.org/medicaid/issue-brief/how-connecting-justice-involved-individuals-to-medicaid-can-help-address-the-opioid-epidemic/
  3. Bryce Ward and Brandon Bridge, The Economic Impact of Medicaid Expansion in Montana: Updated Findings (Bureau of Business and Economic Research, January 2019), https://mthcf.org/wp-content/uploads/2019/01/Economic-Impact-of-MedEx-in-MT_1.28.19-FINAL.pdf
  4. Paul Jacobs, Genevieve Kenney, and Thomas Selden, “Newly Eligible Enrollees In Medicaid Spend Less And Use Less Care Than Those Previously Eligible,” Health Affairs 36, no. 9 (September 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0252
  5. Deborah Bachrach, Patricia Boozang, Avi Herring, and Dori Glanz Reyneri, States Expanding Medicaid See Significant Budget Savings and Revenue Gains, (Manatt Health Solutions, prepared by the Robert Wood Johnson Foundation’s State Health Reform Assistance Network, March 2016), http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2016/rwjf419097
  6. Stan Dorn, Norton Francis, Laura Snyder, and Robin Rudowitz, The Effects of the Medicaid Expansion on State Budgets: An Early Look in Select States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, March 2015), http://kff.org/medicaid/issue-brief/the-effects-of-the-medicaid-expansion-on-state-budgets-an-early-look-in-select-states/

SINGLE STATE STUDIES (back to top)

  1. Stephan R. Lindner et al., “Health Care Expenditures Among Adults With Diabetes After Oregon’s Medicaid Expansion,” Diabetes Care Epub ahead of print (December 2019), https://doi.org/10.2337/dc19-1343
  2. Heather Holderness et al., “Where Do Oregon Medicaid Enrollees Seek Outpatient Care Post-Affordable Care Act Medicaid Expansion?,” Medical Care 57, no. 10 (October 2019): 788-794, https://doi.org/10.1097/mlr.0000000000001189
  3. Helen Levy et al., “Macroeconomic Feedback Effects of Medicaid Expansion: Evidence from Michigan,” Journal of Health Politics, Policy and Law Epub ahead of print (October 2019), https://doi.org/10.1215/03616878-7893555
  4. James A. Richardson, Jared J. Llorens, and Roy L. Heidelberg. Medicaid Expansion and the Louisiana Economy, 2018 and 2019 (Louisiana Department of Health, Prepared by Louisiana State University, August 2019), http://ldh.la.gov/assets/media/3and4.2019FinalReportMedicaidExpansionstudy.pdf
  5. Mark Duggan, Atul Gupta, and Emilie Jackson, The Impact of the Affordable Care Act: Evidence from California’s Hospital Sector (National Bureau of Economic Research, working paper no. 25488, January 2019), https://www.nber.org/papers/w25488.pdf
  6. Aaron McNay, Amy Watson, Barbara Wagner, and Chris Bradley, Montana Medicaid and Montana Employers (Montana Department of Revenue and Montana Department of Labor & Industry, January 2019), http://lmi.mt.gov/Portals/193/Publications/LMI-Pubs/Special%20Reports%20and%20Studies/MT-Medicaid_Report.pdf
  7. Susan Dorr Goold et al., “Primary Care Clinicians’ Views About the Impact of Medicaid Expansion in Michigan: A Mixed Methods Study,” Journal of General Internal Medicine 33, no. 8 (June 2018): 1307-1316, https://link.springer.com/article/10.1007/s11606-018-4487-6
  8. Manatt Health, Medicaid Expansion: How It Affects Montana’s State Budget, Economy, and Residents (Montana Healthcare Foundation, prepared by Manatt Health, June 2018), https://mthcf.org/wp-content/uploads/2018/06/Manatt-MedEx_FINAL_6.1.18.pdf
  9. James Richardson, Jared Llorens, and Roy Heidelberg, Medicaid Expansion and the Louisiana Economy (Louisiana Department of Health, March 2018), http://gov.louisiana.gov/assets/MedicaidExpansion/MedicaidExpansionStudy.pdf
  10. Bela Gorman and Jenn Smagula, 2016 Actuarial Analysis of NH Premium Assistance Program, (Gorman Actuarial, Inc., August 2017), https://www.nh.gov/insurance/reports/documents/08-28-17-ga-nh-pap-analysis-final.pdf
  11. Louisiana Department of Health, Medicaid Expansion 2016/17 (Baton Rouge, Louisiana Department of Health, June 2017), http://dhh.louisiana.gov/assets/HealthyLa/Resources/MdcdExpnAnnlRprt_2017_WEB.pdf
  12. John Ayanian, Gabriel Ehrlich, Donald Grimes, and Helen Levy, “Economic Effects of Medicaid Expansion in Michigan,” The New England Journal of Medicine epub ahead of print (January 2017), http://www.nejm.org/doi/full/10.1056/NEJMp1613981
  13. Pennsylvania Department of Human Services, Medicaid Expansion Report, (Pennsylvania Department of Human Services, January 2017), http://www.dhs.pa.gov/cs/groups/webcontent/documents/document/c_257436.pdf
  14. The Colorado Health Institute, Medicaid Expansion in Colorado: An Analysis of Enrollment, Costs and Benefits—and How They Exceeded Expectations (The Colorado Health Institute, May 2016), http://www.coloradohealthinstitute.org/uploads/postfiles/MK_Expansion_Report.pdf
  15. The Colorado Health Foundation, Assessing the Economic and Budgetary Impact of Medicaid Expansion in Colorado, (The Colorado Health Foundation, March 2016), https://www.coloradohealth.org/sites/default/files/documents/2017-01/Medicaid_ExecutiveSummary_ONLINE.pdf
  16. Lee A. Reynis, Economic and Fiscal Impacts of the Medicaid Expansion in New Mexico, (The University of New Mexico Bureau of Business and Economic Research, February 2016), http://bber.unm.edu/media/publications/Medicaid_Expansion_Final2116R.pdf
  17. Abby Evans, John Folkemer, Joel Menges, Amira Mouna, Nick Pantaleo, Emily Ricci, and Poornima Sigh, Assessment of Medicaid Expansion and Reform, Initial Analysis (The Menges Group, January 2016), https://alaskamentalhealthtrust.org/wp-content/uploads/2018/08/HandOut-MedicaidExpansionAndReformInitialAnalysis-011516-TheMengesGroup.pdf
  18. Chris Brown and John Bennett, Economic Impacts of the Arkansas Private Option (Regional Economic Models, Inc., August 2015), http://www.arkhospitals.org/Misc.%20Files/August2015APOEconomicImpacts.pdf
  19. Deloitte Development LLC, Commonwealth of Kentucky Medicaid Expansion Report, (Deloitte Development LLC, February 2015), http://jointhehealthjourney.com/images/uploads/channel-files/Kentucky_Medicaid_Expansion_One-Year_Study_FINAL.pdf

Impact on Payer Mix for Hospitals, Clinics, and Other Providers

NATIONWIDE STUDIES (back to top)

  1. Meera N. Harhay, Ryan M. McKenna, and Michael O. Harhay, “Association Between Medicaid Expansion Under the Affordable Care Act and Medicaid-Covered Pre-emptive Kidney Transplantation,” Journal of General Internal Medicine 34, no. 11 (November 2019): 2322-2325, https://doi.org/10.1007/s11606-019-05279-x
  2. Johanna Maclean and Brendan Saloner, “The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act,” Journal of Policy Analysis and Management 38, no. 2 (Spring 2019): 366-393, https://www.ncbi.nlm.nih.gov/pubmed/30882195
  3. Christina Andrews et al., “Medicaid Coverage In Substance Use Disorder Treatment After The Affordable Care Act,” Journal of Substance Abuse Treatment epub ahead of print (April 2019), https://www.sciencedirect.com/science/article/pii/S0740547218305750
  4. Michel Boudreaux, Yoon Choi, Liyang Xie, and Daniel Marthey, “Medicaid Expansion at Title X Clinics: Client Volume, Payer Mix, and Contraceptive Method Type,” Medical Care epub ahead of print (April 2019), https://www.ncbi.nlm.nih.gov/pubmed/30973473
  5. Ramin Mojtabai, Christine Mauro, Melanie Wall, Colleen Barry, and Mark Olfson, “The Affordable Care Act and Opioid Agonist Therapy for Opioid Use Disorder,” Psychiatry Online (April 2019), https://doi.org/10.1176/appi.ps.201900025
  6. Jordan Rhodes, Thomas Buchmueller, Helen Levy, and Sayeh Nikpay, “Heterogeneous Effects Of The Aca Medicaid Expansion On Hospital Financial Outcomes,” Contemporary Economic Policy epub ahead of print (April 2019), https://onlinelibrary.wiley.com/doi/full/10.1111/coep.12428
  7. Tyler McClintock, Ye Wang, Mahek Shah, Benjamin Chung, and Steven Chang, “How Have Hospital Pricing Practices for Surgical Episodes of Care Responded to Affordable Care Act-Related Medicaid Expansion?” Urology 125 (March 2019): 79-85, https://doi.org/10.1016/j.urology.2018.10.034
  8. Gary Young, Stephen Flaherty, E. Zepeda, Simone Singh, and Sara Rosenbaum, “Impact of ACA Medicaid Expansion on Hospitals’ Financial Status” Journal of Healthcare Management 64, no. 2 (March 2019): 91–102, https://insights.ovid.com/crossref?an=00115514-201904000-00007
  9. J.W. Awori Hayanga et al., “Lung Transplantation and Affordable Care Act Medicaid Expansion in the Era of Lung Allocation Score” Transplant International epub ahead of print (February 2019), https://onlinelibrary.wiley.com/doi/pdf/10.1111/tri.13420
  10. Rishi Wadhera et al., “Association of State Medicaid Expansion With Quality of Care and Outcomes for Low-Income Patients Hospitalized With Acute Myocardial Infarction,” JAMA Cardiology 4, no. 2 (January 2019): 120-127, https://jamanetwork.com/journals/jamacardiology/article-abstract/2720425?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamacardio.2018.4577
  11. Meera Harhay et al., “Association between Medicaid Expansion under the Affordable Care Act and Preemptive Listings for Kidney Transplantation,” Clinical Journal of the American Society of Nephrology 13 (July 2018), https://cjasn.asnjournals.org/content/13/7/1069
  12. Megan Cole, Brad Wright, Ira Wilson, Omar Gallarraga, and Amal Trivedi, “Medicaid Expansion And Community Health Centers: Care Quality And Service Use Increased For Rural Patients” Health Affairs 37, no. 6 (June 2018), https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2017.1542
  13. Angelica Meinhofer and Allison Witman, “The Role Of Health Insurance On Treatment For Opioid Use Disorders: Evidence From The Affordable Care Act Medicaid Expansion,” Journal of Health Economics 60 (June 2018): 177-197, https://www.sciencedirect.com/science/article/abs/pii/S0167629617311530
  14. Rishi Wadhera et al., “Association of the Affordable Care Act’s Medicaid Expansion With Care Quality and Outcomes for Low-Income Patients Hospitalized With Heart Failure,” Cardiovascular Quality and Outcomes 11, no. 7 (June 2018), https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.004729
  15. Rachel Garfield, Elizabeth Hinton, Elizabeth Cornachione, and Cornelia Hall, Medicaid Managed Care Plans and Access to Care: Results from the Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/report/medicaid-managed-care-plans-and-access-to-care-results-from-the-kaiser-family-foundation-2017-survey-of-medicaid-managed-care-plans
  16. Sara Rosenbaum, Jennifer Tolbert, Jessica Sharac, Peter Shin, Rachel Gunsalus, and Julia Zur, Community Health Centers: Growing Importance in a Changing Health Care System (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/issue-brief/community-health-centers-growing-importance-in-a-changing-health-care-system/
  17. Nicolas Ajkay et al, “Early Impact of Medicaid Expansion and Quality of Breast Cancer Care in Kentucky,” Journal of the American College of Surgeons, epub ahead of print, February 2018, https://www.sciencedirect.com/science/article/pii/S107275151830022X
  18. Richard Lindrooth, Marcelo Perraillon, Rose Hardy, and Gregory Tung, “Understanding the Relationship Between Medicaid Expansions and Hospital Closures,” Health Affairs epub ahead of print (January 2018), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0976
  19. Andrew Loehrer et al., “Association of the Affordable Care Act Medicaid Expansion with Access to and Quality of Care for Surgical Conditions,” Journal of the American Medical Association Surgery, epub ahead of print (January 2018), https://jamanetwork.com/journals/jamasurgery/article-abstract/2670459?redirect=true
  20. Allen Dobson, Joan DaVanzo, Randy Haught, and Phap Hoa Luu, Comparing the Affordable Care Act’s Financial Impact on Safety-Net Hospitals in States that Expanded Medicaid and Those That Did Not (The Commonwealth Fund, November 2017), http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2017/nov/dobson_impact_medicaid_expanion_safety_net_hosps_ib.pdf
  21. Jacob Vogler, Access to Health Care and Criminal Behavior: Short-Run Evidence from the ACA Medicaid Expansions (University of Illinois at Urbana-Champaign, November 2017), https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3042267
  22. Kurt Gillis, Physicians’ Patient Mix – A Snapshot from the 2016 Benchmark Survey and Changes Associated with the ACA (American Medical Association, October 2017), https://www.ama-assn.org/sites/default/files/media-browser/public/health-policy/PRP-2017-physician-benchmark-survey-patient-mix.pdf
  23. Heather Angier et al., “Uninsured Primary Care Visit Disparities under the Affordable Care Act,” Annals of Family Medicine, 15 no. 5 (September 2017): 434-442, http://www.annfammed.org/content/15/5/434.full.pdf+html
  24. Sayeh Nikpay, Seth Freedman, Helen Levy, and Tom Buchmueller, “Effect of the Affordable Care Act Medicaid Expansion on Emergency Department Visits: Evidence From State-Level Emergency Department Databases,” Annals of Emergency Medicine 70, no.2 (August 2017), http://www.annemergmed.com/article/S0196-0644(17)30319-0/pdf
  25. Dmitry Tumin et al., “Medicaid Participation among Liver Transplant Candidates after the Affordable Care Act Medicaid Expansion” Journal of the American College of Surgeons 225, no. 2 (August 2017): 173-180.e2, https://www.journalacs.org/article/S1072-7515(17)30454-4/fulltext
  26. Gary Pickens et al., “Changes in Hospital Inpatient Utilization Following Health Care Reform,” Health Services Research epub ahead of print (June 2017), https://www.ncbi.nlm.nih.gov/pubmed/28664983
  27. Susan Camilleri, “The ACA Medicaid Expansion, Disproportionate Share Hospitals, and Uncompensated Care” Health Services Research epub ahead of print (May 2017), http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12702/abstract
  28. David Dranove, Craig Garthwaite, and Christopher Ody, The Impact of the ACA’s Medicaid Expansion on Hospitals’ Uncompensated Care Burden and the Potential Effects of Repeal, (The Commonwealth Fund, May 2017), http://www.commonwealthfund.org/publications/issue-briefs/2017/may/aca-medicaid-expansion-hospital-uncompensated-care
  29. Fredric Blavin, How Has the ACA Changed Finances for Different Types of Hospitals? Updated Insights from 2015 Cost Report Data (The Urban Institute, April 2017), http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2017/rwjf436310
  30. Craig Garthwaite, Tal Gross, Matthew Notowidigdo, and John Graves, “Insurance Expansion and Hospital Emergency Department Access: Evidence from the Affordable Care Act,” Annals of Internal Medicine 166 no. 3 (February 2017): 172-179, http://annals.org/aim/article/2593599/insurance-expansion-hospital-emergency-department-access-evidence-from-affordable-care
  31. Megan Cole, Omar Galarraga, Ira Wilson, Brad Wright, and Amal Trivedi, “At Federally Funded Health Centers, Medicaid Expansion was Associated with Improved Quality of Care,” Health Affairs 36 no. 1 (January 2017): 40-48, http://content.healthaffairs.org/content/36/1/40.full?sid=a3089120-6f4b-428b-bba8-5f005b444e19
  32. Xinxin Han, Quian Luo, and Leighton Ku, “Medicaid Expansion and Grant Funding Increases Helped Improve Community Health Center Capacity,” Health Affairs 36 no. 1 (January 2017): 49-56, http://content.healthaffairs.org/content/36/1/49.full?sid=a3089120-6f4b-428b-bba8-5f005b444e19
  33. Fredric Blavin, “Association Between the 2014 Medicaid Expansion and US Hospital Finances,” The Journal of the American Medical Association 316 no. 14 (October 2016): 1475-1483, http://jamanetwork.com/journals/jama/article-abstract/2565750
  34. Brystana Kaufman, Kristin Reiter, George Pink, and George Holmes, “Medicaid Expansion Affects Rural and Urban Hospitals Differently,” Health Affairs 35 no. 9 (September 2016): 1665-1672, http://content.healthaffairs.org/content/35/9/1665.full?sid=4aea494e-8e02-4c66-8298-3c828bfc313b
  35. Mary Anderson, Jeffrey Glasheen, Debra Anoff, “Impact of State Medicaid Expansion Status on Length of Stay and In-Hospital Mortality for General Medicine Patients at US Academic Medical Centers,” Journal of Hospital Medicine Epub ahead of print (August 2016), http://onlinelibrary.wiley.com/wol1/doi/10.1002/jhm.2649/citedby
  36. David Dranove, Craig Garthwaite, and Christopher Ody, “Uncompensated Care Decreased At Hospitals In Medicaid Expansion States But Not At Hospitals In Nonexpansion States,” Health Affairs 35 no. 8 (August 2016): 1471-1479, http://content.healthaffairs.org/content/35/8/1471.full
  37. Jesse M. Pines, Mark Zocchi, Ali Moghtaderi, Bernard Black, Steven A. Farmer, Greg Hufstetler, Kevin Klauer and Randy Pilgrim, “Medicaid Expansion In 2014 Did Not Increase Emergency Department Use But Did Change Insurance Payer Mix,” Health Affairs 35, no. 8 (August 2016), http://content.healthaffairs.org/content/35/8/1480.full
  38. Peter Cunningham, Robin Rudowitz, Katherine Young, Rachel Garfield, and Julia Foutz, Understanding Medicaid Hospital Payments and the Impact of Recent Policy Changes (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, June 2016), http://kff.org/medicaid/issue-brief/understanding-medicaid-hospital-payments-and-the-impact-of-recent-policy-changes/
  39. Brendan Saloner, Sachini Bandara, Emma McGinty, and Colleen Barry, “Justice-Involved Adults With Substance Use Disorders: Coverage Increased but Rates of Treatment Did Not in 2014,” Health Affairs 35 no. 6 (June 2016), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.0005
  40. Dmitry Tumin, Don Hayes Jr., Kenneth Washburn, Joseph Tobias, and Sylvester Black, “Medicaid Enrollment after Liver Transplantation: Effects of Medicaid Expansion,” Liver Transplantation (May 2016), http://www.ncbi.nlm.nih.gov/pubmed/27152888
  41. Matt Warfield, Barbara DiPietro, and Samantha Artiga, How has the ACA Medicaid Expansion Affected Providers Serving the Homeless Population: Analysis of Coverage, Revenues, and Costs (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, March 2016), https://files.kff.org/attachment/issue-brief-how-has-the-aca-medicaid-expansion-affected-providers-serving-the-homeless-population
  42. Peter Shin, Jessica Sharac, Julia Zur, Sara Rosenbaum, and Julia Paradise, Health Center Patient Trends, Enrollment Activities, and Service Capacity: Recent Experience in Medicaid Expansion and Non-Expansion States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, December 2015), http://kff.org/medicaid/issue-brief/health-center-patient-trends-enrollment-activities-and-service-capacity-recent-experience-in-medicaid-expansion-and-non-expansion-states/
  43. Deborah Bachrach, Patricia Boozang, and Mindy Lipson, The Impact of Medicaid Expansion on Uncompensated Care Costs: Early Results and Policy Implications for States, (Manatt Health Solutions, prepared by the Robert Wood Johnson Foundation’s State Health Reform Assistance Network, June 2015), https://www.manatt.com/uploadedFiles/Content/5_Insights/White_Papers/State-Network-Manatt-Impact-of-Medicaid-Expansion-on-Uncompensated-Care-Costs-June-2015.pdf
  44. Josh Gray, Iyue Sung, and Stewart Richardson, Observations on the Affordable Care Act: 2014 (athenaResearch and Robert Wood Johnson Foundation ACA View Report, February 2015), http://www.athenahealth.com/~/media/athenaweb/files/pdf/acaview_year_end_2014.pdf
  45. Thomas DeLeire, Karen Joynt, and Ruth McDonald, Impact of Insurance Expansion on Hospital Uncompensated Care Costs in 2014 (Office of the Assistant Secretary for Planning and Evaluation, September 2014), https://aspe.hhs.gov/sites/default/files/pdf/77061/ib_UncompensatedCare.pdf
  46. PricewaterhouseCoopers LLP Health Research Institute, Medicaid 2.0: Health System Haves and Have Nots (PwC Health Research Institute, September 2014), http://www.pwc.com/us/en/health-industries/health-research-institute/assets/pwc-hri-medicaid-report-final.pdf

MULTI-STATE STUDIES (back to top)

  1. Emanuel Eguia et al., “The Impact of the Affordable Care Act Medicaid Expansion on Vascular Surgery,” Annals of Vascular Surgery Epub ahead of print (January 2020), https://doi.org/10.1016/j.avsg.2020.01.006
  2. Hawazin W. Elani, Ichiro Kawachi, and Benjamin D. Sommers, “Changes in Emergency Department Dental Visits after Medicaid Expansion,” Health Services Research Epub ahead of print (January 2020), https://doi.org/10.1111/1475-6773.13261
  3. Alexander T. Janke, Shooshan Danagoulian, Arjun K. Venkatesh, and Phillip D. Levy, “Medicaid Expansion and Resource Utilization in the Emergency Department,” The American Journal of Emergency Medicine Epub ahead of print (January 2020), https://doi.org/10.1016/j.ajem.2019.12.050
  4. Mark Clapp et al., “Association of Medicaid Expansion With Coverage and Access to Care for Pregnant Women,” Obstetrics & Gynecology 134, no. 5 (November 2019): 1066-1074, https://doi.org/10.1097/aog.0000000000003501
  5. Hefei Wen, Kenton J. Johnston, Lindsay Allen, and Teresa M. Waters, “Medicaid Expansion Associated With Reductions In Preventable Hospitalizations,” Health Affairs 38, no. 11 (November 2019): 1845-1849, https://doi.org/10.1377/hlthaff.2019.00483
  6. Nadia Laniado, Avery R. Brow, Eric Tranby, and Victor M. Badner, “Trends in Non-Traumatic Dental Emergency Department Use in New York and New Jersey: A Look at Medicaid Expansion from Both Sides of the Hudson River,” Journal of Public Health Dentistry Epub ahead of print (October 2019), https://doi.org/10.1111/jphd.12343
  7. Elizabeth A. Brown et al., “The Impact of the ACA Medicaid Expansion on Access to Care and Hospitalization Charges for Lupus Patients,” Arthritis Care & Research Epub ahead of print (September 2019), https://doi.org/10.1002/acr.24080
  8. Craig Garthwaite et al., All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act (National Bureau of Economic Research, Working Paper No. 26289, September 2019), http://www.nber.org/papers/w26289
  9. Emanuel Eguia et al., “The Impact of the Affordable Care Act (ACA) Medicaid Expansion on Access to Minimally Invasive Surgical Care,” The American Journal of Surgery Epub ahead of print (July 2019), https://doi.org/10.1016/j.amjsurg.2019.07.003
  10. Andrew Crocker et al., “Expansion Coverage And Preferential Utilization Of Cancer Surgery Among Racial And Ethnic Minorities And Low-Income Groups,” Surgery epub ahead of print (June 2019), https://www.surgjournal.com/article/S0039-6060(19)30198-9/fulltext
  11. Ramiro Manzano-Nunez et al., “Association of Medicaid Expansion Policy with Outcomes in Homeless Patients Requiring Emergency General Surgery,” World Journal of Surgery 43, no. 6 (June 2019): 1483-1489, https://link.springer.com/article/10.1007/s00268-019-04932-0
  12. Rahul Ladhania, Amelia Haviland, Arvind Venkat, Rahul Telang, and Jesse Pines, “The Effect of Medicaid Expansion on the Nature of New Enrollees’ Emergency Department Use,” Medical Care Research and Review epub ahead of print (May 2019), https://journals.sagepub.com/doi/abs/10.1177/1077558719848270
  13. Favel Mondesir et al., “Medicaid Expansion and Hospitalization for Ambulatory Care–Sensitive Conditions Among Nonelderly Adults With Diabetes,” Journal of Ambulatory Care Management epub ahead of print (May 2019), https://insights.ovid.com/pubmed?pmid=31107800
  14. Heather Angier et al., “Racial/Ethnic Disparities in Health Insurance and Differences in Visit Type for a Population of Patients with Diabetes after Medicaid Expansion” Journal of Health Care for the Poor and Underserved 30, no.1, (March 2019) 116–130: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429963/
  15. Jesse Pines, Rahul Ladhania BTech, Bernard Black , Christopher Corbit, Jestin Carlson, and Arvind Venkat, “Changes in Reimbursement to Emergency Physicians After Medicaid Expansion Under the Patient Protection and Affordable Care Act,” Annals of Emergency Medicine 73, no. 3 (March 2019): 213-224, https://www.sciencedirect.com/science/article/pii/S019606441831374X
  16. Cheryl Zogg et al., “Association of Medicaid Expansion With Access to Rehabilitative Care in Adult Trauma Patients,” JAMA Surgery epub ahead of print (January 2019), https://jamanetwork.com/journals/jamasurgery/article-abstract/2719270?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamasurg.2018.5177
  17. Cheryl Zogg et al., “Impact of Affordable Care Act Insurance Expansion on Pre-Hospital Access to Care: Changes in Adult Perforated Appendix Admission Rates after Medicaid Expansion and the Dependent Coverage Provision,” Journal of the American College of Surgeons 228, no. 1 (January 2019): 29-43, https://www.journalacs.org/article/S1072-7515(18)32078-7/fulltext
  18. Nathalie Huguet et al., “The Impact of the Affordable Care Act (ACA) Medicaid Expansion on Visit Rates for Diabetes in Safety Net Health Centers,” Journal of the American Board of Family Medicine 31, no. 6 (November 2018): 905-916, https://www.jabfm.org/content/31/6/905.full
  19. Emanuel Eguia et al., “Impact of the Affordable Care Act (ACA) Medicaid Expansion on Cancer Admissions and Surgeries,” Annals of Surgery 268, no. 4 (October 2018): 584-590, https://journals.lww.com/annalsofsurgery/Abstract/2018/10000/Impact_of_the_Affordable_Care_Act__ACA__Medicaid.6.aspx
  20. Manzilat Akande Peter Minneci, Katherine Deans, Henry Xiang, and Jennifer Cooper, “Association of Medicaid Expansion Under the Affordable Care Act With Outcomes and Access to Rehabilitation in Young Adult Trauma Patients,” JAMA Surgery 153, no. 8 (August 2018), https://jamanetwork.com/journals/jamasurgery/article-abstract/2682872?widget=personalizedcontent&previousarticle=2719270
  21. Ehimare Akhabue, Lindsay Pool, Clyde Yancy, Philip Greenland, and Donald Lloyd-Jones, “Association of State Medicaid Expansion With Rate of Uninsured Hospitalizations for Major Cardiovascular Events, 2009-2014,” JAMA Network Open 1, no. 4 (August 2018), https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2698077
  22. Vivian Wu et al., “Early Impact of the Affordable Care Act Coverage Expansion on Safety-Net Hospital Inpatient Payer Mix and Market Shares,” Health Services Research (January 2018), http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12812/full
  23. Monique Barakat et al., “Affordable Care Act and Healthcare Delivery: A Comparison of California and Florida Hospitals and Emergency Departments,” PLoS ONE 12 no. 8 (August 2017), http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0182346
  24. Eric Charles et al., “Impact of Medicaid Expansion on Cardiac Surgery Volume and Outcomes,” The Annals of Thoracic Surgery (June 2017), http://www.annalsthoracicsurgery.org/article/S0003-4975(17)30552-0/pdf
  25. Nathalie Huguet et al., “Medicaid Expansion Produces Long-Term Impact on Insurance Coverage Rates in Community Health Centers,” Journal of Primary Care & Community Health epub ahead of print (May 2017), http://journals.sagepub.com/doi/full/10.1177/2150131917709403
  26. Laurie Felland, Peter Cunningham, Annie Doubleday, and Cannon Warren, Effects of the Affordable Care Act on Safety Net Hospitals (Washington, DC: Mathematica Policy Research, prepared for the Assistant Secretary for Planning and Evaluation, November 2016), https://aspe.hhs.gov/sites/default/files/pdf/255491/SafetyNetHospital.pdf
  27. Megan Hoopes, Heather Angier, Rachel Gold, Steffani Bailey, Nathalie Huguet, Miguel Marino, and Jennifer DeVoe, “Utilization of Community Health Centers in Medicaid Expansion and Nonexpansion States, 2013-2014,” Journal of Ambulatory Care Management 39 no. 4 (October 2016): 290-298, https://www.ncbi.nlm.nih.gov/pubmed/26765808
  28. Steven Wallace, Maria-Elena Young, Michael Rodriguez, Amy Bonilla, and Nadereh Pourat, Community Health Centers Play a Critical Role in Caring for the Remaining Uninsured in the Affordable Care Act Era (UCLA Center for Health Policy Research, October 2016), http://healthpolicy.ucla.edu/publications/Documents/PDF/2016/FQHC_PB-oct2016.pdf
  29. Jane Wishner, Patricia Solleveld, Robin Rudowitz, Julia Paradise, and Larisa Antonisse, A Look at Rural Hospital Closures and Implications for Access to Care: Three Case Studies (Washington, DC: Kaiser Commission on Medicaid and the Uninsured and The Urban Institute, July 2016), http://kff.org/medicaid/issue-brief/a-look-at-rural-hospital-closures-and-implications-for-access-to-care/
  30. Stephen Berry et al., “Healthcare Coverage for HIV Provider Visits before and after Implementation of the Affordable Care Act,” Clinical Infectious Diseases, (May 2016), http://www.ncbi.nlm.nih.gov/pubmed/27143660
  31. Sayeh Nikpay, Thomas Buchmueller, and Helen Levy. “Affordable Care Act Medicaid Expansion Reduced Uninsured Hospital Stays in 2014,” Health Affairs 35, no.1 (January 2016): 106-110, http://content.healthaffairs.org/content/35/1/106.full
  32. Fred Hellinger, “In Four ACA Expansion States, The Percentage of Uninsured Hospitalizations for People With HIV Declined, 2012-14,” Health Affairs 34, no. 12 (December 2015): 2061-2068, http://search.proquest.com/docview/1749932806/627DA95CDEA44BE7PQ/77?accountid=39486#
  33. Robin Rudowitz and Rachel Garfield, New Analysis Shows States with Medicaid Expansion Experienced Declines in Uninsured Hospital Discharges (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, September 2015), http://kff.org/health-reform/issue-brief/new-analysis-shows-states-with-medicaid-expansion-experienced-declines-in-uninsured-hospital-discharges/
  34. Samantha Artiga, Jennifer Tolbert, and Robin Rudowitz, Year Two of the ACA Coverage Expansions: On-the-Ground Experiences from Five States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, June 2015), http://kff.org/health-reform/issue-brief/year-two-of-the-aca-coverage-expansions-on-the-ground-experiences-from-five-states/
  35. Peter Cunningham, Rachel Garfield, and Robin Rudowitz, How Are Hospitals Faring Under the Affordable Care Act? Early Experiences from Ascension Health (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, April 2015), http://kff.org/health-reform/issue-brief/how-are-hospitals-faring-under-the-affordable-care-act-early-experiences-from-ascension-health/
  36. Colorado Hospital Association, Impact of Medicaid Expansion on Hospital Volumes (Colorado Hospital Association Center for Health Information and Data Analytics, June 2014), http://www.cha.com/documents/press-releases/cha-medicaid-expansion-study-june-2014.aspx

SINGLE STATE STUDIES (back to top)

  1. Charles A. Daly et al., “The Effects of Medicaid Expansion on Triage and Regional Transfer After Upper-Extremity Trauma,” The Journal of Hand Surgery 44, no. 9 (September 2019): 720-727, https://doi.org/10.1016/j.jhsa.2019.05.020
  2. Beatrice D. Probst, Luther Walls, Michael Cirone, and Talar Markossian, “Examining the Effect of the Affordable Care Act on Two Illinois Emergency Departments,” Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health 20, no. 5 (September 2019): 710-716, https://doi.org/10.5811/westjem.2019.6.41943
  3. John Scott et al., “Lifting the Burden: State Medicaid Expansion Reduces Financial Risk for the Injured,” Journal of Trauma and Acute Care Surgery Epub ahead of print (September 2019), https://doi.org/10.1097/ta.0000000000002493
  4. Neal Bhutiani, Brian Harbrecht, Charles Scoggins, and Matthew Bozeman, “Evaluating The Early Impact Of Medicaid Expansion On Trends In Diagnosis And Treatment Of Benign Gallbladder Disease In Kentucky,” The American Journal of Surgery (January 2019), https://www.americanjournalofsurgery.com/article/S0002-9610(18)30894-8/fulltext
  5. Mark Duggan, Atul Gupta, and Emilie Jackson, The Impact of the Affordable Care Act: Evidence from California’s Hospital Sector (National Bureau of Economic Research, working paper no. 25488, January 2019), https://www.nber.org/papers/w25488.pdf
  6. Manatt Health, Medicaid Expansion: How It Affects Montana’s State Budget, Economy, and Residents (Montana Healthcare Foundation, prepared by Manatt Health, June 2018), https://mthcf.org/wp-content/uploads/2018/06/Manatt-MedEx_FINAL_6.1.18.pdf
  7. Shannon McConville, Maria Raven, Sarah Sabbagh, and Renee Hsia, “Frequent Emergency Department Users: A Statewide Comparison Before And After Affordable Care Act Implementation,” Health Affairs 37, no. 6, (June 2018), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0784
  8. Donald Likosky, Devraj Sukul, Milan Seth, Chang He, Hitlander Gurm, and Richard Prager, “The Association Between Medicaid Expansion and Cardiovascular Interventions: The Michigan Experience,” Journal of the American College of Cardiology 71, no. 9 (March 2018): 1050-1051, https://www.sciencedirect.com/science/article/pii/S0735109718300056?via%3Dihub
  9. Eili Klein et al., “The Effect of Medicaid Expansion on Utilization in Maryland Emergency Departments,” Annals of Emergency Medicine epub ahead of print (June 2017), http://www.annemergmed.com/article/S0196-0644(17)30784-9/pdf
  10. Pennsylvania Department of Human Services, Medicaid Expansion Report, (Pennsylvania Department of Human Services, January 2017), http://www.dhs.pa.gov/cs/groups/webcontent/documents/document/c_257436.pdf
  11. Natalia Chalmers, Jane Grover, and Rob Compton, “After Medicaid Expansion in Kentucky, Use of Hospital Emergency Departments for Dental Conditions Increased,” Health Affairs 35, no. 12 (December 2016), http://content.healthaffairs.org/content/35/12/2268.full#xref-ref-32-1
  12. The University of Michigan Institute for Healthcare Policy & Innovation, The Healthy Michigan Plan: 2015 Report on Uncompensated Care and Insurance Rates (The University of Michigan Institute for Healthcare Policy & Innovation, prepared for the Michigan Department of Health and Human Services and the Michigan Department of Insurance and Financial Services, December 2016), http://www.michigan.gov/documents/mdhhs/2015_Report_on_Uncompensated_Care_and_Insurance_Rates-HMP_547720_7.pdf
  13. Mathew Davis, Achamyeleh Gebremariam, John Ayanian, “Changes in Insurance Coverage Among Hospitalized Nonelderly Adults After Medicaid Expansion in Michigan,” The Journal of the American Medical Association 315 no. 23 (June 2016): 2617-2618, http://jamanetwork.com/journals/jama/fullarticle/2529615
  14. Abby Evans, John Folkemer, Joel Menges, Amira Mouna, Nick Pantaleo, Emily Ricci, and Poornima Sigh, Assessment of Medicaid Expansion and Reform, Initial Analysis (The Menges Group, January 2016), https://alaskamentalhealthtrust.org/wp-content/uploads/2018/08/HandOut-MedicaidExpansionAndReformInitialAnalysis-011516-TheMengesGroup.pdf
  15. Arkansas Health Reform Legislative Task Force, Health Care Task Force Preliminary Report, (Arkansas Health Reform Legislative Task Force, December 2015), http://www.arkleg.state.ar.us/assembly/2015/Meeting%20Attachments/836/I14218/Task%20Force%20report%2012-17-15%20sent%20to%20Jill.pdf
  16. Jocelyn Guyer, Naomi Shine, MaryBeth Musumeci, and Robin Rudowitz, A Look at the Private Option in Arkansas (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, August 2015), http://kff.org/medicaid/issue-brief/a-look-at-the-private-option-in-arkansas/
  17. Christine Jones, Serena Scott, Debra Anoff, Read Pierce, Jeffrey Glasheen, “Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion,” Inquiry: The Journal of Health Care Organization, Provision, and Financing 52 (August 2015), http://inq.sagepub.com/content/52/0046958015602464.full
  18. Michael McCue, “The Impact of Medicaid Expansion on Medicaid Focused Insurers in California,” Inquiry: The Journal of Health Care Organization, Provision, and Financing 52 (July 2015), http://inq.sagepub.com/content/52/0046958015595960.full.pdf+html
  19. Deloitte Development LLC, Commonwealth of Kentucky Medicaid Expansion Report, (Deloitte Development LLC, February 2015), http://jointhehealthjourney.com/images/uploads/channel-files/Kentucky_Medicaid_Expansion_One-Year_Study_FINAL.pdf
  20. Arkansas Hospital Association, “Survey Reveals Private Option Impact on Hospitals,” The Notebook 21, no. 33 (November 2014), http://www.arkhospitals.org/archive/notebookpdf/Notebook_11-03-14.pdf

Impact on Employment and the Labor Market

NATIONWIDE STUDIES (back to top)

  1. Olga Scrivner et al., “Job Postings in the Substance Use Disorder Treatment Related Sector During the First Five Years of Medicaid Expansion,” PLoS One 15, no. 1 (January 2020), https://doi.org/10.1371/journal.pone.0228394
  2. Renuka Tipirneni et al., “Association of Medicaid Expansion With Enrollee Employment and Student Status in Michigan,” JAMA Network Open 3, no. 1 (January 2020), https://doi.org/10.1001/jamanetworkopen.2019.20316
  3. Thomas C. Buchmueller, Helen G. Levy, and Robert G. Valletta, Medicaid Expansion and the Unemployed (National Bureau of Economic Research, Working Paper No. 26553, December 2019), http://www.nber.org/papers/w26553
  4. Lizhong Peng, Xiaohui Guo, and Chad D. Meyerhoefer, “The Effects of Medicaid Expansion on Labor Market Outcomes: Evidence from Border Counties,” Health Economics Epub ahead of print (December 2019), https://doi.org/10.1002/hec.3976
  5. Lucie Schmidt, Lara Shore-Sheppard, and Tara Watson, The Impact of the ACA Medicaid Expansion on Disability Program Applications (National Bureau of Economic Research, Working Paper No. 26192, August 2019), http://www.nber.org/papers/w26192
  6. Jean Hall, Adele Shartzer, Noelle Kurth, and Kathleen Thomas, “Medicaid Expansion as an Employment Incentive Program for People With Disabilities,” American Journal of Public Health epub ahead of print (July 2018), https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2018.304536
  7. Kevin Callison and Paul Sicilian, “Economic Freedom and the Affordable Care Act: Medicaid Expansions and Labor Mobility by Race and Ethnicity,” Public Finance Review 46, no. 2 (March 2018), https://journals.sagepub.com/doi/abs/10.1177/1091142116668254
  8. Aparna Soni, Marguerite Burns, Laura Dague, and Kosali Simon, “Medicaid Expansion and State Trends in Supplemental Security Income Program Participation,” Health Affairs 36 no. 8, (August 2017): 1485-1488, http://content.healthaffairs.org/content/36/8/1485.full?sid=982b20c0-0a17-4dc4-a35a-b0302d4ec289
  9. Pauline Leung and Alexandre Mas, Employment Effects of the ACA Medicaid Expansions (Working Paper No. 22540, National Bureau of Economic Research, August 2016), http://www.nber.org/papers/w22540
  10. Angshuman Gooptu, Asako Moriya, Kosali Simon, and Benjamin Sommers, “Medicaid Expansion Did Not Result in Significant Employment Changes or Job Reductions in 2014,” Health Affairs 35, no. 1 (January 2016): 111-118, 1-12, http://content.healthaffairs.org/content/35/1/111.short
  11. Robert Kaestner, Bowen Garrett, Anuj Gangopadhyaya, and Caitlyn Fleming, Effects of ACA Medicaid Expansions on Health Insurance Coverage and Labor Supply (Working Paper No. 21836, National Bureau of Economic Research, December 2015), http://www.nber.org/papers/w21836
  12. Bowen Garrett and Robert Kaestner, Recent Evidence on the ACA and Employment: Has the ACA Been a Job Killer? (Washington, DC: The Urban Institute and the Robert Wood Johnson Foundation, August 2015), http://www.urban.org/research/publication/recent-evidence-aca-and-employment-has-aca-been-job-killer/view/full_report

MULTI-STATE STUDIES (back to top)

  1. Priyanka Anand, Jody Schimmel Hyde, Maggie Colby, and Paul O’Leary, “The Impact of Affordable Care Act Medicaid Expansions on Applications to Federal Disability Programs,” Forum for Health Economics and Policy (February 2019), https://www.ncbi.nlm.nih.gov/pubmed/30796844
  2. Bryce Ward and Brandon Bridge, The Economic Impact of Medicaid Expansion in Montana: Updated Findings (Bureau of Business and Economic Research, January 2019), https://mthcf.org/wp-content/uploads/2019/01/Economic-Impact-of-MedEx-in-MT_1.28.19-FINAL.pdf

SINGLE STATE STUDIES (back to top)

  1. Renuka Tipirneni et al., “Association of Expanded Medicaid Coverage With Health and Job-Related Outcomes Among Enrollees With Behavioral Health Disorders,” Psychiatric Services Epub ahead of print (September 2019), https://doi.org/10.1176/appi.ps.201900179
  2. James A. Richardson, Jared J. Llorens, and Roy L. Heidelberg. Medicaid Expansion and the Louisiana Economy, 2018 and 2019 (Louisiana Department of Health, Prepared by Louisiana State University, August 2019), http://ldh.la.gov/assets/media/3and4.2019FinalReportMedicaidExpansionstudy.pdf
  3. The Ohio Department of Medicaid, 2018 Ohio Medicaid Group VIII Assessment: A FollowUp to the 2016 Ohio Medicaid Group VIII Assessment, (The Ohio Department of Medicaid, August 2018), https://medicaid.ohio.gov/Portals/0/Resources/Reports/Annual/Group-VIII-Final-Report.pdf
  4. Susan Dorr Goold et al., “Primary Care Clinicians’ Views About the Impact of Medicaid Expansion in Michigan: A Mixed Methods Study,” Journal of General Internal Medicine 33, no. 8 (June 2018): 1307-1316, https://link.springer.com/article/10.1007/s11606-018-4487-6
  5. James Richardson, Jared Llorens, and Roy Heidelberg, Medicaid Expansion and the Louisiana Economy (Louisiana Department of Health, March 2018), http://gov.louisiana.gov/assets/MedicaidExpansion/MedicaidExpansionStudy.pdf
  6. John Ayanian, Gabriel Ehrlich, Donald Grimes, and Helen Levy, “Economic Effects of Medicaid Expansion in Michigan,” The New England Journal of Medicine epub ahead of print (January 2017), http://www.nejm.org/doi/full/10.1056/NEJMp1613981
  7. The Colorado Health Foundation, Assessing the Economic and Budgetary Impact of Medicaid Expansion in Colorado, (The Colorado Health Foundation, March 2016), https://www.coloradohealth.org/sites/default/files/documents/2017-01/Medicaid_ExecutiveSummary_ONLINE.pdf
  8. Deloitte Development LLC, Commonwealth of Kentucky Medicaid Expansion Report, (Deloitte Development LLC, February 2015), http://jointhehealthjourney.com/images/uploads/channel-files/Kentucky_Medicaid_Expansion_One-Year_Study_FINAL.pdf

Additional Emerging Studies (back to top)

  1. Michel Boudreaux, James M. Noon, Brett Fried, and Joanne Pascale, “Medicaid Expansion and the Medicaid Undercount in the American Community Survey,” Health Services Research 54, no. 6 (December 2019): 1263-1272, https://doi.org/10.1111/1475-6773.13213
  2. Emily Brown, Michelle Garrison, Hao Bao, Pingping Qu, Carole Jenny, and Ali Rowhani-Rahbar, “Assessment of Rates of Child Maltreatment in States With Medicaid Expansion vs States Without Medicaid Expansion,” JAMA Network Open 2, no. 6 (June 2019), https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2735758
  3. Daniel Hopkins and Kalind Parish, “The Medicaid Expansion and Attitudes toward the Affordable Care Act: Testing for a Policy Feedback on Mass Opinion,” Public Opinion Quarterly 83, no. 1 (April 2019): 123-134, https://academic.oup.com/poq/article-abstract/83/1/123/5430239
  4. Richard Fording and Dana Patton, “Medicaid Expansion and the Political Fate of the Governors Who Support It,” Policy Studies Journal 47, no. 2 (January 2019), https://onlinelibrary.wiley.com/doi/full/10.1111/psj.12311
  5. Joshua Clinton and Michael Sances, “The Politics of Policy: The Initial Mass Political Effects of Medicaid Expansion in the States,” American Political Science Review 112, no. 1 (February 2018): 167-185, https://www.cambridge.org/core/journals/american-political-science-review/article/politics-of-policy-the-initial-mass-political-effects-of-medicaid-expansion-in-the-states/246AA0F10B44EFD62A7B27C661730823
  6. Jake Haselswerdt, “Expanding Medicaid, Expanding the Electorate: The Affordable Care Act’s Short-Term Impact on Political Participation,” Journal of Health Politics, Policy, and Law 42, no. 4 (August 2017), https://read.dukeupress.edu/jhppl/article-abstract/42/4/667/130386/Expanding-Medicaid-Expanding-the-Electorate-The?redirectedFrom=fulltext
  7. Michael Sances and Joshua Clinton, New Policy, New Politics? The Effect of Medicaid Expansion on Public Support for the Affordable Care Act, (University of Memphis and Vanderbilt University, February 2017), https://csap.yale.edu/sites/default/files/files/apppw_jc2_3-8-17.pdf
  8. David Slusky and Donna Ginther, Did Medicaid Expansion Reduce Medical Divorce? (Working Paper No. 23139, National Bureau of Economic Research, February 2017), http://www.nber.org/papers/w23139?utm_campaign=ntw&utm_medium=email&utm_source=ntw
  9. Lucas Goodman, “The Effect of the Affordable Care Act Medicaid Expansion on Migration,” Journal of Policy Analysis 36, no. 1 (November 2016): 211-238, http://onlinelibrary.wiley.com/doi/10.1002/pam.21952/abstract

Bibliography

  1. Jean M. Abraham, Anne B. Royalty, and Coleman Drake, “The Impact of Medicaid Expansion on Employer Provision of Health Insurance,” International Journal of Health Economics and Management 19, no. 3-4 (December 2019): 317-340, https://doi.org/10.1007/s10754-018-9256-x
  2. Amanda Abraham et al., “Changes in State Technical Assistance Priorities and Block Grant Funds for Addiction After ACA Implementation,” American Journal of Public Health epub ahead of print (May 2019), https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2019.305052
  3. Andrew Admon, Thomas Valley, John Ayanian, Theodore Iwashyna, Colin Cooke, and Renuka Tipirneni, “Trends in Hospital Utilization After Medicaid Expansion,” Medical Care 57, no. 4 (April 2019): 312-317, https://journals.lww.com/lww-medicalcare/Abstract/publishahead/Brief_Report__Trends_in_Hospital_Utilization_After.98489.aspx
  4. Andrew Admon, Michael Sjoding, Sarah Lyon, John Ayanian, Theodore Iwashyna, and Colin Cooke, “Medicaid Expansion and Mechanical Ventilation in Asthma, Chronic Obstructive Pulmonary Disease, and Heart Failure,” Annals of the American Thoracic Society epub ahead of print (February 2019), https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201811-777OC
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  6. Ankit Agarwal, Aaron Katz, and Ronald Chen, “The Impact of the Affordable Care Act on Disparities in Private and Medicaid Insurance Coverage among Patients Under 65 with Newly Diagnosed Cancer,” International Journal of Radiation Oncology, Biology, Physics (May 2019), https://www.redjournal.org/article/S0360-3016(19)30783-7/pdf
  7. Nicolas Ajkay et al, “Early Impact of Medicaid Expansion and Quality of Breast Cancer Care in Kentucky,” Journal of the American College of Surgeons, epub ahead of print, February 2018, https://www.sciencedirect.com/science/article/pii/S107275151830022X
  8. Manzilat Akande, Peter Minneci, Katherine Deans, Henry Xiang, Deena Chisolm, and Jennifer Cooper, “Effects Of Medicaid Expansion On Disparities In Trauma Care And Outcomes In Young Adults,” Journal of Surgical Research 228 (August 2018): 42-53, https://www.sciencedirect.com/science/article/pii/S0022480418301562
  9. Manzilat Akande Peter Minneci, Katherine Deans, Henry Xiang, and Jennifer Cooper, “Association of Medicaid Expansion Under the Affordable Care Act With Outcomes and Access to Rehabilitation in Young Adult Trauma Patients,” JAMA Surgery 153, no. 8 (August 2018), https://jamanetwork.com/journals/jamasurgery/article-abstract/2682872?widget=personalizedcontent&previousarticle=2719270
  10. Ehimare Akhabue, Lindsay Pool, Clyde Yancy, Philip Greenland, and Donald Lloyd-Jones, “Association of State Medicaid Expansion With Rate of Uninsured Hospitalizations for Major Cardiovascular Events, 2009-2014,” JAMA Network Open 1, no. 4 (August 2018), https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2698077
  11. Abeer Alharbi, M. Mahmud Khan, Ronnie Horner, Heather Brandt, and Cole Chapman, “Impact Of Medicaid Coverage Expansion Under The Affordable Care Act On Mammography And Pap Tests Utilization Among Low-Income Women,” PLOS One (April 2019), https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214886
  12. Adam M. Almaguer et al., “Do Geographic Region, Medicaid Status, and Academic Affiliation Affect Access to Care Among Medicaid and Privately Insured Total Hip Arthroplasty Patients?,” Journal of Arthroplasty 34, no. 12 (December 2019): 2866-2871, https://doi.org/10.1016/j.arth.2019.07.030
  13. Priyanka Anand, Jody Schimmel Hyde, Maggie Colby, and Paul O’Leary, “The Impact of Affordable Care Act Medicaid Expansions on Applications to Federal Disability Programs,” Forum for Health Economics and Policy (February 2019), https://www.ncbi.nlm.nih.gov/pubmed/30796844
  14. Mary Anderson, Jeffrey Glasheen, Debra Anoff, “Impact of State Medicaid Expansion Status on Length of Stay and In-Hospital Mortality for General Medicine Patients at US Academic Medical Centers,” Journal of Hospital Medicine Epub ahead of print (August 2016), http://onlinelibrary.wiley.com/wol1/doi/10.1002/jhm.2649/citedby
  15. Christina Andrews et al., “Medicaid Coverage In Substance Use Disorder Treatment After The Affordable Care Act,” Journal of Substance Abuse Treatment epub ahead of print (April 2019), https://www.sciencedirect.com/science/article/pii/S0740547218305750
  16. Heather Angier et al., “Racial/Ethnic Disparities in Health Insurance and Differences in Visit Type for a Population of Patients with Diabetes after Medicaid Expansion” Journal of Health Care for the Poor and Underserved 30, no.1, (March 2019) 116–130: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429963/
  17. Heather Angier et al., “Uninsured Primary Care Visit Disparities under the Affordable Care Act,” Annals of Family Medicine, 15 no. 5 (September 2017): 434-442,http://www.annfammed.org/content/15/5/434.full.pdf+html
  18. Arkansas Health Reform Legislative Task Force, Health Care Task Force Preliminary Report, (Arkansas Health Reform Legislative Task Force, December 2015), http://www.arkleg.state.ar.us/assembly/2015/Meeting%20Attachments/836/I14218/Task%20Force%20report%2012-17-15%20sent%20to%20Jill.pdf
  19. Arkansas Hospital Association, “Survey Reveals Private Option Impact on Hospitals,” The Notebook 21, no. 33 (November 2014), http://www.arkhospitals.org/archive/notebookpdf/Notebook_11-03-14.pdf
  20. Samantha Artiga, Barbara DiPietro, and Petry Ubri, The Role of Medicaid and the Impact of the Medicaid Expansion for Veterans Experiencing Homelessness, (Washington, DC: Kaiser Family Foundation, October 2017), https://www.kff.org/medicaid/issue-brief/the-role-of-medicaid-and-impact-of-the-medicaid-expansion-for-veterans-experiencing-homelessness/
  21. Samantha Artiga and Robin Rudowitz, How Have State Medicaid Expansion Decisions Affected the Experiences of Low-Income Adults? Perspectives from Ohio, Arkansas, and Missouri (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, June 2015), http://kff.org/medicaid/issue-brief/how-have-state-medicaid-expansion-decisions-affected-the-experiences-of-low-income-adults-perspectives-from-ohio-arkansas-and-missouri/
  22. Samantha Artiga, Robin Rudowitz, Jennifer Tolbert, Julia Paradise, and Melissa Majerol, Findings from the Field: Medicaid Delivery Systems and Access to Care in Four States in Year Three of the ACA (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, September 2016), http://kff.org/medicaid/issue-brief/findings-from-the-field-medicaid-delivery-systems-and-access-to-care-in-four-states-in-year-three-of-the-aca/
  23. Samantha Artiga, Jennifer Tolbert, and Robin Rudowitz, Year Two of the ACA Coverage Expansions: On-the-Ground Experiences from Five States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, June 2015), http://kff.org/health-reform/issue-brief/year-two-of-the-aca-coverage-expansions-on-the-ground-experiences-from-five-states/
  24. Natoshia Askelson, Brad Wright, Suzanne Bentler, Elizabeth Momany, and Peter Damiano, “Iowa’s Medicaid Expansion Promoted Healthy Behaviors But Was Challenging to Implement and Attracted Few Participants,” Health Affairs 36 no. 5, (May 2017): 799-807, http://content.healthaffairs.org/content/36/5/799.full
  25. Susan L. Averett, Julie K. Smith, and Yang Wang, “Medicaid Expansion and Opioid Deaths,” Health Economics 28, no. 12 (December 2019): 1491-1496, https://doi.org/10.1002/hec.3945
  26. Kelsey Avery, Kenneth Finegold, and Amelia Whitman, Affordable Care Act Has Led to Historic, Widespread Increase in Health Insurance Coverage (Office of the Assistant Secretary for Planning and Evaluation, September 2016), https://aspe.hhs.gov/sites/default/files/pdf/207946/ACAHistoricIncreaseCoverage.pdf
  27. John Ayanian, Gabriel Ehrlich, Donald Grimes, and Helen Levy, “Economic Effects of Medicaid Expansion in Michigan,” The New England Journal of Medicine epub ahead of print (January 2017), http://www.nejm.org/doi/full/10.1056/NEJMp1613981
  28. Deborah Bachrach, Patricia Boozang, Avi Herring, and Dori Glanz Reyneri, States Expanding Medicaid See Significant Budget Savings and Revenue Gains, (Manatt Health Solutions, prepared by the Robert Wood Johnson Foundation’s State Health Reform Assistance Network, March 2016), http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2016/rwjf419097
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  33. Abigail Barker, Kelsey Huntzberry, Timothy McBride, and Keith Mueller, Changing Rural and Urban Enrollment in State Medicaid Programs (Iowa City, IA: Rural Policy Research Institute, May 2017), https://cph.uiowa.edu/rupri/publications/policybriefs/2017/Changing%20Rural%20and%20Urban%20Enrollment%20in%20State%20Medicaid%20Programs.pdf
  34. Stephen Barnes, Mike Henderson, Dek Terrell, and Stephanie Virgets, 2017 Louisiana Health Insurance Survey (Louisiana Department of Health, prepared by the Louisana State University E.J. Ourso College of Business, August 2018), http://ldh.la.gov/assets/media/2017-Louisiana-Health-Insurance-Survey-Report.pdf
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  330. Alana Sharp, Austin Jones, Jennifer Sherwood, Oksana Kutsa, Brian Honermann, and Gregorio Millett, “Impact of Medicaid Expansion on Access to Opioid Analgesic Medications and Medication-Assisted Treatment,” American Journal of Public Health 108, no. 5 (May 2018): 642-648, https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2018.304338?journalCode=ajph
  331. Adele Shartzer, Frederic Blavin, and John Holohan, “Employer-Sponsored Insurance Stable For Low-Income Workers In Medicaid Expansion States,” Health Affairs 37, no. 4 (April 2018), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.1205
  332. Adele Shartzer, Sharon Long, and Nathaniel Anderson, “Access To Care and Affordability have Improved Following Affordable Care Act Implementation; Problems Remain,” Health Affairs (December 2015), http://content.healthaffairs.org/content/early/2015/12/14/hlthaff.2015.0755.full
  333. Peter Shin, Jessica Sharac, Julia Zur, Sara Rosenbaum, and Julia Paradise, Health Center Patient Trends, Enrollment Activities, and Service Capacity: Recent Experience in Medicaid Expansion and Non-Expansion States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, December 2015), http://kff.org/medicaid/issue-brief/health-center-patient-trends-enrollment-activities-and-service-capacity-recent-experience-in-medicaid-expansion-and-non-expansion-states/
  334. Chelsea L. Shover et al., “The Relationship of Medicaid Expansion to Psychiatric Comorbidity Care within Substance Use Disorder Treatment Programs,” Journal of Substance Abuse Treatment 105 (October 2019): 44-50, https://doi.org/10.1016/j.jsat.2019.07.012
  335. Kosali Simon, Aparna Soni, and John Cawley, “The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions” Journal of Policy Analysis and Management 36, no. 2 (March 2017), https://onlinelibrary.wiley.com/doi/abs/10.1002/pam.21972
  336. Helmneh M. Sineshaw et al., “Association of Medicaid Expansion Under the Affordable Care Act With Stage at Diagnosis and Time to Treatment Initiation for Patients With Head and Neck Squamous Cell Carcinoma,” JAMA Otolaryngology–Head & Neck Surgery Epub ahead of print (January 2020), https://doi.org/10.1001/jamaoto.2019.4310
  337. Astha Singhal, Peter Damiano, and Lindsay Sabik, “Medicaid Adult Dental Benefits Increase Use Of Dental Care, But Impact Of Expansion On Dental Services Use Was Mixed,” Health Affairs 36 no. 4 (April 2017): 723-732, http://content.healthaffairs.org/content/36/4/723.short
  338. Laura Skopec, John Holahan, and Caroline Elmendorf, Changes in Health Insurance Coverage 2013–2016: Medicaid Expansion States Lead the Way, (Washington, DC: The Urban Institute, September 2018), https://www.urban.org/sites/default/files/publication/98989/changes_in_health_insurance_coverage_2013-2016_medicaid_expansion_states_lead_the_way_1.pdf
  339. Laura Skopec, John Holahan, and Caroline Elmendorf, Health Insurance Coverage Declined for Nonelderly Americans Between 2016 and 2017, Primarily in States That Did Not Expand Medicaid (Washington, DC: The Urban Institute, August 2019), https://www.urban.org/research/publication/health-insurance-coverage-declined-nonelderly-americans-between-2016-and-2017-primarily-states-did-not-expand-medicaid
  340. David Slusky and Donna Ginther, Did Medicaid Expansion Reduce Medical Divorce? (Working Paper No. 23139, National Bureau of Economic Research, February 2017), http://www.nber.org/papers/w23139?utm_campaign=ntw&utm_medium=email&utm_source=ntw
  341. Jessica Smith and Carla Medalia, Health Insurance Coverage in the United States: 2014 (U.S. Census Bureau, September 2015), https://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-253.pdf
  342. Laura Snyder, Katherine Young, Robin Rudowitz, and Rachel Garfield, Medicaid Expansion Spending and Enrollment in Context: An Early Look at CMS Claims Data for 2014 (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, January 2016), http://kff.org/medicaid/issue-brief/medicaid-expansion-spending-and-enrollment-in-context-an-early-look-at-cms-claims-data-for-2014/
  343. Aaron Sojourner and Ezra Golberstein, “Medicaid Expansion Reduced Unpaid Medical Debt and Increased Financial Satisfaction,” Health Affairs (July 2017), https://www.healthaffairs.org/do/10.1377/hblog20170724.061160/full/
  344. Benjamin Sommers, Robert Blendon, and E. John Orav, “Both the ‘Private Option’ And Traditional Medicaid Expansions Improved Access To Care For Low-Income Adults,” Health Affairs 35, no. 1 (January 2016): 96-105, http://content.healthaffairs.org/content/35/1/96.abstract
  345. Benjamin Sommers, Robert Blendon, E. John Orav, and Arnold Epstein, “Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance,” The Journal of the American Medical Association 176 no. 10 (October 2016): 1501-1509, http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2542420
  346. Benjamin Sommers, Carrie Fry, Robert Blendon, and Arnold Epstein, “New Approaches in Medicaid: Work Requirements, Health Savings Accounts, and Health Care Access,” Health Affairs 37, no. 7 (June 2018), https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2018.0331
  347. Benjamin Sommers, Anna Goldman, Robert Blendon, E. John Orav, and Arnold Epstein, “Medicaid Work Requirements – Results from the First Year in Arkansas,” The New England Journal of Medicine Special Report (June 2019), https://www.nejm.org/doi/full/10.1056/NEJMsr1901772
  348. Benjamin Sommers, Rebecca Gourevitch, Bethany Maylone, Robert Blendon, and Arnold Epstein, “Insurance Churning Rates for Low-Income Adults Under Health Reform: Lower Than Expected but Still Harmful for Many,” Health Affairs 35 no. 10 (October 2016): 1816-1824, http://content.healthaffairs.org/content/35/10/1816.full?sid=f4835910-ffd0-4864-a76a-b4f207ccd018
  349. Benjamin Sommers and Jonathan Gruber, “Federal Funding Insulated State Budgets From Increased Spending Related To Medicaid Expansion,” Health Affairs epub ahead of print (April 2017), http://content.healthaffairs.org/content/early/2017/04/10/hlthaff.2016.1666.full
  350. Benjamin Sommers, Munira Gunja, Kenneth Finegold, and Thomas Musco, “Changes in Self-Reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act,” The Journal of the American Medical Association 314 no. 4 (July 2015): 366-374, http://jama.jamanetwork.com/article.aspx?articleid=2411283&resultClick=3
  351. Benjamin Sommers, Bethany Maylone, Robert Blendon, E. John Orav, and Arnold Epstein, “Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults,” Health Affairs epub ahead of print (May 2017), http://content.healthaffairs.org/content/early/2017/05/15/hlthaff.2017.0293
  352. Benjamin Sommers, Thomas Musco, Kenneth Finegold, Munira Gunja, Amy Burke, and Audrey McDowell, “Health Reform and Changes in Health Insurance Coverage in 2014” The New England Journal of Medicine 371 (August 2014): 867-874, http://www.nejm.org/doi/full/10.1056/NEJMsr1406753
  353. Aparna Soni, Marguerite Burns, Laura Dague, and Kosali Simon, “Medicaid Expansion and State Trends in Supplemental Security Income Program Participation,” Health Affairs 36 no. 8, (August 2017): 1485-1488, http://content.healthaffairs.org/content/36/8/1485.full?sid=982b20c0-0a17-4dc4-a35a-b0302d4ec289
  354. Aparna Soni, Michael Hendryx, and Kosali Simon, “Medicaid Expansion under the Affordable Care Act and Insurance Coverage in Rural and Urban Areas,” The Journal of Rural Health epub ahead of print (January 2017), http://onlinelibrary.wiley.com/doi/10.1111/jrh.12234/full
  355. Aparna Soni, Lindsay Sabik, Kosali Simon, and Benjamin Sommers, “Changes in Insurance Coverage Among Cancer Patients Under the Affordable Care Act,” Journal of the American Medical Association 4, no. 1 (January 2018): 122-124, https://jamanetwork.com/journals/jamaoncology/article-abstract/2657670?redirect=true&redirect=true
  356. Aparna Soni, Kosali Simon, John Cawley, and Lindsay Sabik, “Effect of Medicaid Expansions of 2014 on Overall and Early-Stage Cancer Diagnoses,” American Journal of Public Health epub ahead of print (December 2017), http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2017.304166
  357. Jim P. Stimpson, Jessie Kemmick Pintor, and Fernando A. Wilson, “Association of Medicaid Expansion with Health Insurance Coverage by Marital Status and Sex,” PLoS One 14, no. 10 (October 2019), https://doi.org/10.1371/journal.pone.0223556
  358. Jim Stimpson and Fernando Wilson, “Medicaid Expansion Improved Health Insurance Coverage For Immigrants, But Disparities Persist,” Health Affairs 37, no. 10 (October 2018), https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0181
  359. Jim P. Stimpson et al., “Association of Medicaid Expansion With Health Insurance Coverage Among Persons With a Disability,” JAMA Network Open 2, no. 7 (July 2019), https://doi.org/10.1001/jamanetworkopen.2019.7136
  360. Shailender Swaminathan, Benjamin Sommers, Rebecca Thorsness, Rajnish Mehrotra, Yoojin Lee, and Amal Trivedi, “Association of Medicaid Expansion With 1-Year Mortality Among Patients With End-Stage Renal Disease,” Journal of the American Medical Association (JAMA) 320, no. 21 (December 2018): 2242-2250, https://jamanetwork.com/journals/jama/fullarticle/2710505?guestAccessKey=ea3a8641-320b-4afd-b96e-dc59fbd90b20&utm_source=TrendMD&utm_medium=cpc&utm_campaign=J_Am_Med_TrendMD_1&utm_content=olf&utm_term=102518
  361. James A. Swartz and Susanny J. Beltran, “Prescription Opioid Availability and Opioid Overdose-Related Mortality Rates in Medicaid Expansion and Non-Expansion States,” Addiction 114, no. 11 (November 2019): 2016-2025, https://doi.org/10.1111/add.14741
  362. Renuka Tipirneni et al., “Association of Expanded Medicaid Coverage With Health and Job-Related Outcomes Among Enrollees With Behavioral Health Disorders,” Psychiatric Services Epub ahead of print (September 2019), https://doi.org/10.1176/appi.ps.201900179
  363. Renuka Tipirneni et al., “Association of Medicaid Expansion With Enrollee Employment and Student Status in Michigan,” JAMA Network Open 3, no. 1 (January 2020), https://doi.org/10.1001/jamanetworkopen.2019.20316
  364. Renuka Tipirneni et al., “Changes in Health and Ability to Work Among Medicaid Expansion Enrollees: a Mixed Methods Study,” Journal of General Internal Medicine 34, no. 2 (February 2019): 272-280, https://link.springer.com/article/10.1007/s11606-018-4736-8
  365. Renuka Tipirneni et al., “Primary Care Appointment Availability For New Medicaid Patients Increased After Medicaid Expansion In Michigan,” Health Affairs (July 2015), http://content.healthaffairs.org/content/early/2015/07/15/hlthaff.2014.1425.full
  366. Renuka Tipirneni et al., “Primary Care Appointment Availability and Nonphysician Providers One Year After Medicaid Expansion,” The American Journal of Managed Care 22 no. 6 (June 2016): 427-431, http://www.ajmc.com/journals/issue/2016/2016-vol22-n6/primary-care-appointment-availability-and-nonphysician-providers-one-year-after-medicaid-expansion
  367. Dmitry Tumin et al., “Medicaid Participation among Liver Transplant Candidates after the Affordable Care Act Medicaid Expansion” Journal of the American College of Surgeons 225, no. 2 (August 2017): 173-180.e2, https://www.journalacs.org/article/S1072-7515(17)30454-4/fulltext
  368. Dmitry Tumin, Don Hayes Jr., Kenneth Washburn, Joseph Tobias, and Sylvester Black, “Medicaid Enrollment after Liver Transplantation: Effects of Medicaid Expansion,” Liver Transplantation (May 2016), http://www.ncbi.nlm.nih.gov/pubmed/27152888
  369. Sri Lekha Tummalapalli, Samuel Leonard, Michelle M. Estrella, and Salomeh Keyhani, “The Effect of Medicaid Expansion on Self-Reported Kidney Disease,” Clinical Journal of American Society of Nephrology 14, no. 8 (August 2019): 1238-1240, https://doi.org/10.2215/cjn.02310219
  370. United States Government Accountability Office (GAO), Medicaid Expansion: Behavioral Health Treatment Use in Selected States in 2014 (Washington, DC: GAO Report to Congressional Requesters, June 2017), https://www.gao.gov/assets/690/685415.pdf
  371. The University of Michigan Institute for Healthcare Policy & Innovation, The Healthy Michigan Plan: 2015 Report on Uncompensated Care and Insurance Rates (The University of Michigan Institute for Healthcare Policy & Innovation, prepared for the Michigan Department of Health and Human Services and the Michigan Department of Insurance and Financial Services, December 2016), http://www.michigan.gov/documents/mdhhs/2015_Report_on_Uncompensated_Care_and_Insurance_Rates-HMP_547720_7.pdf
  372. Nimish Valvi, Neomi Vin-Raviv, and Tomi Akinyemiju, “Current Smoking and Quit-Attempts Among US Adults Following Medicaid Expansion,” Preventive Medicine Reports epub ahead of print (June 2019), https://www.sciencedirect.com/science/article/pii/S2211335519300981
  373. Jessica Vistnes and Joel Cohen, “Duration of Uninsured Spells For Nonelderly Adults Declined After 2014,” Health Affairs 37, no. 6 (June 2018), https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.1638
  374. Jessica Vistnes and Joel Cohen, “Gaining Coverage in 2014: New Estimates of Marketplace and Medicaid Transitions,” Health Affairs 35 no. 10 (October 2016): 1825-1829, http://content.healthaffairs.org/content/35/10/1825.full?sid=cc385dd5-9c95-4ee1-9c58-888408d49c54
  375. ­­Jacob Vogler, Access to Health Care and Criminal Behavior: Short-Run Evidence from the ACA Medicaid Expansions (University of Illinois at Urbana-Champaign, November 2017), https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3042267
  376. Vikki Wachino and Samantha Artiga, How Connecting Justice-Involved Individuals to Medicaid Can Help Address the Opioid Epidemic (Washington, DC: Kaiser Family Foundation, June 2019), https://www.kff.org/medicaid/issue-brief/how-connecting-justice-involved-individuals-to-medicaid-can-help-address-the-opioid-epidemic/
  377. Rishi Wadhera et al., “Association of the Affordable Care Act’s Medicaid Expansion With Care Quality and Outcomes for Low-Income Patients Hospitalized With Heart Failure,” Circulation: Cardiovascular Quality and Outcomes 11, no. 7 (June 2018), https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.004729
  378. Rishi Wadhera et al., “Association of State Medicaid Expansion With Quality of Care and Outcomes for Low-Income Patients Hospitalized With Acute Myocardial Infarction,” JAMA Cardiology 4, no. 2 (January 2019): 120-127, https://jamanetwork.com/journals/jamacardiology/article-abstract/2720425?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamacardio.2018.4577
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  380. Bryce Ward and Brandon Bridge, The Economic Impact of Medicaid Expansion in Montana: Updated Findings (Bureau of Business and Economic Research, January 2019), https://mthcf.org/wp-content/uploads/2019/01/Economic-Impact-of-MedEx-in-MT_1.28.19-FINAL.pdf
  381. Matt Warfield, Barbara DiPietro, and Samantha Artiga, How has the ACA Medicaid Expansion Affected Providers Serving the Homeless Population: Analysis of Coverage, Revenues, and Costs (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, March 2016), https://files.kff.org/attachment/issue-brief-how-has-the-aca-medicaid-expansion-affected-providers-serving-the-homeless-population
  382. George Wehby and Wei Lyu, “The Impact of the ACA Medicaid Expansions on Health Insurance Coverage through 2015 and Coverage Disparities by Age, Race/Ethnicity, and Gender” Health Services Research epub ahead of print (May 2017), http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12711/abstract
  383. Hefei Wen, Tyrone Borders, and Benjamin Druss, ”Number of Medicaid Prescriptions Grew, Drug Spending was Steady in Medicaid Expansion States,” Health Affairs 35, no. 12 (September 2016): 1604-1607, http://content.healthaffairs.org/content/35/9/1604.full
  384. Hefei Wen, Jason Hockenberry, Tyrone Borders, and Benjamin Druss, “Impact of Medicaid Expansion on Medicaid-covered Utilization of Buprenorphine for Opioid Use Disorder Treatment,” Medical Care 55 no. 4 (April 2017): 336-341, http://journals.lww.com/lww-medicalcare/Fulltext/2017/04000/Impact_of_Medicaid_Expansion_on_Medicaid_covered.5.aspx
  385. Hefei Wen, Kenton J. Johnston, Lindsay Allen, and Teresa M. Waters, “Medicaid Expansion Associated With Reductions In Preventable Hospitalizations,” Health Affairs 38, no. 11 (November 2019): 1845-1849, https://doi.org/10.1377/hlthaff.2019.00483
  386. Hefei Wen, Adam S. Wilk, and Benjamin G. Druss, “Medicaid Acceptance by Psychiatrists Before and After Medicaid Expansion,” JAMA Psychiatry epub ahead of print (June 2019), https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2735109?resultClick=1
  387. Laura Wherry and Sarah Miller, “Early Coverage, Access, Utilization, and Health Effects Associated with the Affordable Care Act Medicaid Expansions: A Quasi-experimental Study,” Annals of Internal Medicine, Epub ahead of print (April 2016), http://annals.org/article.aspx?articleid=2513980
  388. Alanna Williamson, Larisa Antonisse, Jennifer Tolbert, Rachel Garfield, and Anthony Damico, ACA Coverage Expansions and Low-Income Workers (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, June 2016), http://kff.org/report-section/aca-coverage-expansions-and-low-income-workers-issue-brief/
  389. Tyler Winkelman and Virginia Chang, “Medicaid Expansion, Mental Health, and Access to Care Among Childless Adults With and Without Chronic Conditions,” Journal of General Internal Medicine epub ahead of print (November 2017), https://www.ncbi.nlm.nih.gov/pubmed/29181792
  390. Tyler Winkelman, Edith Kieffer, Susan Goold, Jeffrey Morenoff, Kristen Cross, and John Ayanian, “Health Insurance Trends and Access to Behavioral Health Care Among Justice-Involved Individuals,” Journal of General Internal Medicine 31, no. 12 (December 2016): 1523-1529, https://www.ncbi.nlm.nih.gov/pubmed/27638837
  391. Jane Wishner, Patricia Solleveld, Robin Rudowitz, Julia Paradise, and Larisa Antonisse, A Look at Rural Hospital Closures and Implications for Access to Care: Three Case Studies (Washington, DC: Kaiser Commission on Medicaid and the Uninsured and The Urban Institute, July 2016), http://kff.org/medicaid/issue-brief/a-look-at-rural-hospital-closures-and-implications-for-access-to-care/
  392. Christian Wolfe, Kathryn Rennie, and Christopher Truffer, 2017 Actuarial Report on the Financial Outlook for Medicaid (Office of the Actuary, Centers for Medicare and Medicaid Services, September 2018), https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/MedicaidReport2017.pdf
  393. Joanna Woronkowicz, Aparna Soni, Seth Freedman, and Kosali Simon, “How Have Recent Health Insurance Expansions Affected Coverage Among Artist Occupations In The USA?,” Journal of Cultural Economics (May 2019), https://link.springer.com/article/10.1007/s10824-019-09352-5
  394. Brad Wright et al., “Completion of Requirements in Iowa’s Medicaid Expansion Premium Disincentive Program, 2014–2015,” American Journal of Public Health 108, no. 2 (February 2018): 219-223, http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.304178
  395. Vivian Wu et al., “Early Impact of the Affordable Care Act Coverage Expansion on Safety-Net Hospital Inpatient Payer Mix and Market Shares,” Health Services Research (January 2018), http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12812/full
  396. Deborah Yip et al., “Association of Medicaid Expansion and Health Insurance with Receipt of Smoking Cessation Services and Smoking Behaviors in Substance Use Disorder Treatment,” The Journal of Behavioral Health Services & Research (July 2019), https://doi.org/10.1007/s11414-019-09669-1
  397. Gary Young, Stephen Flaherty, E. Zepeda, Simone Singh, and Sara Rosenbaum, “Impact of ACA Medicaid Expansion on Hospitals’ Financial Status” Journal of Healthcare Management 64, no. 2 (March 2019): 91–102, https://insights.ovid.com/crossref?an=00115514-201904000-00007
  398. Dahai Yue, Petra Rasmussen, and Ninez Ponce, “Racial/Ethnic Differential Effects of Medicaid Expansion on Health Care Access,” Health Services Research (February 2018), http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12834/abstract
  399. Yasmin Zerhouni et al., “Effect of Medicaid Expansion on Colorectal Cancer Screening Rates,” Diseases of the Colon & Rectum 62, no. 1 (January 2019): 97-103, https://journals.lww.com/dcrjournal/Abstract/2019/01000/Effect_of_Medicaid_Expansion_on_Colorectal_Cancer.16.aspx
  400. Naomi Zewde, Erica Eliason, Heidi Allen, and Tal Gross, “The Effects of the ACA Medicaid Expansion on Nationwide Home Evictions and Eviction-Court Initiations: United States, 2000-2016,” American Journal of Public Health 109, no. 10 (October 2019): 1379-1383, https://doi.org/10.2105/ajph.2019.305230
  401. Naomi Zewde and Christopher Wimer, “Antipoverty Impact Of Medicaid Growing With State Expansions Over Time,” Health Affairs 38, no. 1 (January 2019), https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05155
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Endnotes

  1. This is an update to four earlier versions of this issue brief that covered studies published through May 2016, January 2017, June 2017, February 2018, and June 2019. ↩︎
  2. Mark Olfson et al., “A National Survey of Trends in Health Insurance Coverage of Low-Income Adults Following Medicaid Expansion,” Journal of General Internal Medicine Epub ahead of print (October 2019), https://doi.org/10.1007/s11606-019-05409-5 ↩︎
  3. John A. Graves et al., “Medicaid Expansion Slowed Rates of Health Decline for Low-Income Adults in Southern States,” Health Affairs 39, no. 1 (January 2020): 67-76, https://doi.org/10.1377/hlthaff.2019.00929 ↩︎
  4. Jim P. Stimpson, Jessie Kemmick Pintor, and Fernando A. Wilson, “Association of Medicaid Expansion with Health Insurance Coverage by Marital Status and Sex,” PLoS One 14, no. 10 (October 2019), https://doi.org/10.1371/journal.pone.0223556 ↩︎
  5. Jim P. Stimpson et al., “Association of Medicaid Expansion With Health Insurance Coverage Among Persons With a Disability,” JAMA Network Open 2, no. 7 (July 2019), https://doi.org/10.1001/jamanetworkopen.2019.7136 ↩︎
  6. Gracie Himmelstein, “Effect of the Affordable Care Act’s Medicaid Expansions on Food Security, 2010-2016,” American Journal of Public Health 109, no. 9 (September 2019): 1243-1248, https://doi.org/10.2105/ajph.2019.305168 ↩︎
  7. Sumit D. Agarwal, Anna L. Goldman, and Benjamin D. Sommers, “Blue-Collar Workers Had Greatest Insurance Gains After ACA Implementation,” Health Affairs 38, no. 7 (July 2019): 1140-1144, https://doi.org/10.1377/hlthaff.2018.05454 ↩︎
  8. Michel Boudreaux, James M. Noon, Brett Fried, and Joanne Pascale, “Medicaid Expansion and the Medicaid Undercount in the American Community Survey,” Health Services Research 54, no. 6 (December 2019): 1263-1272, https://doi.org/10.1111/1475-6773.13213 ↩︎
  9. Hiroshi Gotanda, Gerald Kominski, and Yusuke Tsugawa, “Association Between the ACA Medicaid Expansions and Primary Care and Emergency Department Use During the First 3 Years,” Journal of General Internal Medicine Epub ahead of print (December 2019), https://doi.org/10.1007/s11606-019-05458-w ↩︎
  10. Lucie Schmidt, Lara Shore-Sheppard, and Tara Watson, The Impact of the ACA Medicaid Expansion on Disability Program Applications (National Bureau of Economic Research, Working Paper No. 26192, August 2019), http://www.nber.org/papers/w26192 ↩︎
  11. James A. Richardson, Jared J. Llorens, and Roy L. Heidelberg. Medicaid Expansion and the Louisiana Economy, 2018 and 2019 (Louisiana Department of Health, Prepared by Louisiana State University, August 2019), http://ldh.la.gov/assets/media/3and4.2019FinalReportMedicaidExpansionstudy.pdf ↩︎
  12. Nevada’s Medicaid Population, (Las Vegas, NV: The Guinn Center, September 2019), https://guinncenter.org/wp-content/uploads/2019/09/Guinn-Center-NV-Medicaid-Population-Characteristics-2019.pdf ↩︎
  13. Charles J. Courtemanche et al., The Impact of the ACA on Insurance Coverage Disparities After Four Years (National Bureau of Economic Research, Working Paper No. 26157, August 2019), http://www.nber.org/papers/w26157 ↩︎
  14. Charles J. Courtemanche, James Marton, and Aaron Yelowitz, Medicaid Coverage across the Income Distribution under the Affordable Care Act (National Bureau of Economic Research, Working Paper No. 26145, August 2019), http://www.nber.org/papers/w26145 ↩︎
  15. Sarah Miller and Laura Wherry, “Four Years Later: Insurance Coverage and Access to Care Continue to Diverge between ACA Medicaid Expansion and Non-Expansion States,” American Economic Association Papers and Proceedings 109 (May 2019): 327-333, https://www.aeaweb.org/articles?id=10.1257/pandp.20191046 ↩︎
  16. Charles Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata, and Ishtiaque Fazlul, “The Three‐Year Impact of the Affordable Care Act on Disparities in Insurance Coverage,” Health Services Research (October 2018), https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.13077 ↩︎
  17. Laura Skopec, John Holahan, and Caroline Elmendorf, Changes in Health Insurance Coverage 2013–2016: Medicaid Expansion States Lead the Way, (Washington, DC: The Urban Institute, September 2018), https://www.urban.org/sites/default/files/publication/98989/changes_in_health_insurance_coverage_2013-2016_medicaid_expansion_states_lead_the_way_1.pdf ↩︎
  18. Stephen Barnes, Mike Henderson, Dek Terrell, and Stephanie Virgets, 2017 Louisiana Health Insurance Survey (Louisiana Department of Health, Prepared by the Louisana State University E.J. Ourso College of Business, August 2018), http://ldh.la.gov/assets/media/2017-Louisiana-Health-Insurance-Survey-Report.pdf ↩︎
  19. Pennsylvania Department of Human Services, Medicaid Expansion Report, (Pennsylvania Department of Human Services, January 2017), http://www.dhs.pa.gov/cs/groups/webcontent/documents/document/c_257436.pdf ↩︎
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  474. Brendan Saloner, Jonathan Levin, Hsien-Yen Chang, Christopher Jones, and G. Caleb Alexander, “Changes in Buprenorphine-Naloxone and Opioid Pain Reliever Prescriptions After the Affordable Care Act Medicaid Expansion,” JAMA Network Open 1, no. 4 (August 2018), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2696873 ↩︎
  475. Lisa Clemans-Cope, Marni Epstein, Victoria Lynch, and Emma Winiski, Rapid Growth in Medicaid Spending and Prescriptions to Treat Opioid Use Disorder and Opioid Overdose from 2010 to 2017 (Washington, DC: The Urban Institute, March 2019), https://www.urban.org/sites/default/files/publication/99798/rapid_growth_in_medicaid_spending_and_prescriptions_to_treat_opioid_use_disorder_and_opioid_overdose_from_2010_to_2017_2.pdf ↩︎
  476. Lisa Clemans-Cope, Victoria Lynch, Marni Epstein, and Genevieve Kenney, Medicaid Coverage of Effective Treatment for Opioid Use Disorder, (Washington, DC: The Urban Institute, June 2017), https://www.urban.org/sites/default/files/publication/90461/2001287_medicaid_coverage_of_effective_treatment_for_opioid_use_disorder.pdf ↩︎
  477. Angelica Meinhofer and Allison Witman, “The Role Of Health Insurance On Treatment For Opioid Use Disorders: Evidence From The Affordable Care Act Medicaid Expansion,” Journal of Health Economics 60 (June 2018): 177-197, https://www.sciencedirect.com/science/article/abs/pii/S0167629617311530 ↩︎
  478. Johanna Maclean and Brendan Saloner, “The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act,” Journal of Policy Analysis and Management 38, no. 2 (2019): 366-393, https://www.ncbi.nlm.nih.gov/pubmed/30882195 ↩︎
  479. Hefei Wen, Jason Hockenberry, Tyrone Borders, and Benjamin Druss, “Impact of Medicaid Expansion on Medicaid-covered Utilization of Buprenorphine for Opioid Use Disorder Treatment,” Medical Care 55 no. 4 (April 2017): 336-341, http://journals.lww.com/lww-medicalcare/Fulltext/2017/04000/Impact_of_Medicaid_Expansion_on_Medicaid_covered.5.aspx ↩︎
  480. Brendan Saloner, Rachel Landis, Bradley Stein, and Colleen Barry, “The Affordable Care Act in the Heart of the Opioid Crisis: Evidence from West Virginia,” Health Affairs 38, no. 4 (April 2019), https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05049 ↩︎
  481. Emanuel Eguia et al., “Impact of the Affordable Care Act (ACA) Medicaid Expansion on Cancer Admissions and Surgeries,” Annals of Surgery 268, no. 4 (October 2018): 584-590, https://journals.lww.com/annalsofsurgery/Abstract/2018/10000/Impact_of_the_Affordable_Care_Act__ACA__Medicaid.6.aspx ↩︎
  482. A. Taylor Kelley, Renuka Tipirneni, and Helen Levy, “Changes in Veterans’ Coverage and Access to Care Following the Affordable Care Act, 2011-2017,” American Journal of Public Health 109, no. 9 (September 2019): 1233-1235, https://doi.org/10.2105/ajph.2019.305160 ↩︎
  483. Kevin Griffith, Leigh Evans, and Jacob Bor, “The Affordable Care Act Reduced Socioeconomic Disparities in Health Care Access,” Health Affairs 36 no. 8 (August 2017), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0083 ↩︎
  484. Kelsie M. Gould et al., “Bariatric Surgery Among Vulnerable Populations: The Effect of the Affordable Care Act’s Medicaid Expansion,” Surgery 166, no. 5 (November 2019): 820-828, https://doi.org/10.1016/j.surg.2019.05.005 ↩︎
  485. Shiho Kino and Ichiro Kawachi, “The Impact Of ACA Medicaid Expansion On Socioeconomic Inequality In Health Care Services Utilization,” PLoS ONE 13, no. 2 (December 2018), https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209935 ↩︎
  486. Manzilat Akande, Peter Minneci, Katherine Deans, Henry Xiang, Deena Chisolm, and Jennifer Cooper, “Effects Of Medicaid Expansion On Disparities In Trauma Care And Outcomes In Young Adults,” Journal of Surgical Research 228 (August 2018): 42-53, https://www.sciencedirect.com/science/article/pii/S0022480418301562 ↩︎
  487. Susan Hayes, Pamela Riley, David Radley, and Douglas McCarthy, Reducing Racial and Ethnic Disparities in Access to Care: Has the Affordable Care Act Made a Difference? (The Commonwealth Fund, August 2017), http://www.commonwealthfund.org/publications/issue-briefs/2017/aug/racial-ethnic-disparities-care ↩︎
  488. Cheryl Zogg et al., “Impact of Affordable Care Act Insurance Expansion on Pre-Hospital Access to Care: Changes in Adult Perforated Appendix Admission Rates after Medicaid Expansion and the Dependent Coverage Provision,” Journal of the American College of Surgeons 228, no. 1 (January 2019): 29-43, https://www.journalacs.org/article/S1072-7515(18)32078-7/fulltext ↩︎
  489. Hiroshi Gotanda, Gerald Kominski, and Yusuke Tsugawa, “Association Between the ACA Medicaid Expansions and Primary Care and Emergency Department Use During the First 3 Years,” Journal of General Internal Medicine Epub ahead of print (December 2019), https://doi.org/10.1007/s11606-019-05458-w ↩︎
  490. Alexander T. Janke, Shooshan Danagoulian, Arjun K. Venkatesh, and Phillip D. Levy, “Medicaid Expansion and Resource Utilization in the Emergency Department,” The American Journal of Emergency Medicine Epub ahead of print (January 2020), https://doi.org/10.1016/j.ajem.2019.12.050 ↩︎
  491. Hawazin W. Elani, Ichiro Kawachi, and Benjamin D. Sommers, “Changes in Emergency Department Dental Visits after Medicaid Expansion,” Health Services Research Epub ahead of print (January 2020), https://doi.org/10.1111/1475-6773.13261 ↩︎
  492. Craig Garthwaite et al., All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act (National Bureau of Economic Research, Working Paper No. 26289, September 2019), http://www.nber.org/papers/w26289 ↩︎
  493. Eili Klein et al., “The Effect of Medicaid Expansion on Utilization in Maryland Emergency Departments,” Annals of Emergency Medicine epub ahead of print (June 2017), http://www.annemergmed.com/article/S0196-0644(17)30784-9/pdf ↩︎
  494. Heather Holderness et al., “Where Do Oregon Medicaid Enrollees Seek Outpatient Care Post-Affordable Care Act Medicaid Expansion?,” Medical Care 57, no. 10 (October 2019): 788-794, https://doi.org/10.1097/mlr.0000000000001189 ↩︎
  495. Aabha Sharma, Scott Dresden, Emilie Powell, Raymond Kang, Joe Feinglass, “Emergency Department Visits and Hospitalizations for the Uninsured in Illinois Before and After Affordable Care Act Insurance Expansion,” Journal of Community Health 42 no. 3 (June 2017): 591-597, https://link.springer.com/article/10.1007/s10900-016-0293-4 ↩︎
  496. Rahul Ladhania, Amelia Haviland, Arvind Venkat, Rahul Telang, and Jesse Pines, “The Effect of Medicaid Expansion on the Nature of New Enrollees’ Emergency Department Use,” Medical Care Research and Review epub ahead of print (May 2019), https://journals.sagepub.com/doi/abs/10.1177/1077558719848270 ↩︎
  497. Gary Pickens et al., “Changes In Hospital Service Demand, Cost, And Patient Illness Severity Following Health Reform,” Health Services Research (May 2019), https://doi.org/10.1111/1475-6773.13165 ↩︎
  498. Mark Duggan, Atul Gupta, and Emilie Jackson, The Impact of the Affordable Care Act: Evidence from California’s Hospital Sector (National Bureau of Economic Research, working paper no. 25488, January 2019), https://www.nber.org/papers/w25488.pdf ↩︎
  499. Jesse M. Pines, Mark Zocchi, Ali Moghtaderi, Bernard Black, Steven A. Farmer, Greg Hufstetler, Kevin Klauer and Randy Pilgrim, “Medicaid Expansion In 2014 Did Not Increase Emergency Department Use But Did Change Insurance Payer Mix,” Health Affairs 35, no. 8 (August 2016), http://content.healthaffairs.org/content/35/8/1480.full ↩︎
  500. Benjamin Sommers, Bethany Maylone, Robert Blendon, E. John Orav, and Arnold Epstein, “Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults,” Health Affairs epub ahead of print (May 2017), http://content.healthaffairs.org/content/early/2017/05/15/hlthaff.2017.0293 ↩︎
  501. Stacey McMorrow, Jason Gates, Sharon Long, and Genevieve Kenney, “Medicaid Expansion Increased Coverage, Improved Affordability, and Reduced Psychological Distress for Low-Income Parents,” Health Affairs 36 no. 5 (May 2017): 808-818, https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1650 ↩︎
  502. Manatt Health, Medicaid Expansion: How It Affects Montana’s State Budget, Economy, and Residents (Manatt Health, prepared for the Montana Healthcare Foundation, June 2018), https://mthcf.org/wp-content/uploads/2018/06/Manatt-MedEx_FINAL_6.1.18.pdf ↩︎
  503. Shannon McConville, Maria Raven, Sarah Sabbagh, and Renee Hsia, “Frequent Emergency Department Users: A Statewide Comparison Before And After Affordable Care Act Implementation,” Health Affairs 37, no. 6 (June 2018), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0784 ↩︎
  504. Daniel Gingold, Rachelle Pierre-Mathieu, Brandon Cole, Andrew Miller, and Joneigh Khaldun, “Impact of the Affordable Care Act Medicaid Expansion on Emergency Department High Utilizers with Ambulatory Care Sensitive Conditions: A Cross-Sectional Study,” The American Journal of Emergency Medicine (January 2017), http://www.sciencedirect.com/science/article/pii/S0735675717300141 ↩︎
  505. Benjamin Sommers, Robert Blendon, E. John Orav, Arnold Epstein, “Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance,” The Journal of the American Medical Association 176 no. 10 (October 2016): 1501-1509, http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2542420 ↩︎
  506. Paul Jacobs, Genevieve Kenney, and Thomas Selden, “Newly Eligible Enrollees In Medicaid Spend Less And Use Less Care Than Those Previously Eligible,” Health Affairs 36, no. 9 (September 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0252 ↩︎
  507. Elizabeth A. Brown et al., “The Impact of the ACA Medicaid Expansion on Access to Care and Hospitalization Charges for Lupus Patients,” Arthritis Care & Research Epub ahead of print (September 2019), https://doi.org/10.1002/acr.24080 ↩︎
  508. Charles A. Daly et al., “The Effects of Medicaid Expansion on Triage and Regional Transfer After Upper-Extremity Trauma,” The Journal of Hand Surgery 44, no. 9 (September 2019): 720-727, https://doi.org/10.1016/j.jhsa.2019.05.020 ↩︎
  509. Craig Garthwaite et al., All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act (National Bureau of Economic Research, Working Paper No. 26289, September 2019), http://www.nber.org/papers/w26289 ↩︎
  510. Natalia Chalmers, Jane Grover, and Rob Compton, “After Medicaid Expansion in Kentucky, Use of Hospital Emergency Departments for Dental Conditions Increased,” Health Affairs 35, no. 12 (December 2016), http://content.healthaffairs.org/content/35/12/2268.full#xref-ref-32-1 ↩︎
  511. Benjamin Sommers, Carrie Fry, Robert Blendon, and Arnold Epstein, “New Approaches in Medicaid: Work Requirements, Health Savings Accounts, and Health Care Access,” Health Affairs 37, no. 7 (June 2018), https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2018.0331 ↩︎
  512. MaryBeth Musumeci, Robin Rudowitz, Petry Ubri, and Elizabeth Hinton, An Early Look at Medicaid Expansion Waiver Implementation in Michigan and Indiana (Washington, DC: The Kaiser Family Foundation, January 2017), http://kff.org/medicaid/issue-brief/an-early-look-at-medicaid-expansion-waiver-implementation-in-michigan-and-indiana/ ↩︎
  513. Natoshia Askelson, Brad Wright, Suzanne Bentler, Elizabeth Momany, and Peter Damiano, “Iowa’s Medicaid Expansion Promoted Healthy Behaviors But Was Challenging to Implement and Attracted Few Participants,” Health Affairs 36 no. 5, (May 2017): 799-807, http://content.healthaffairs.org/content/36/5/799.full ↩︎
  514. The Lewin Group, Indiana Healthy Indiana Plan 2.0: Interim Evaluation Report (The Lewin Group, Prepared for Indiana Family and Social Services Administration, July 2016), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/Healthy-Indiana-Plan-2/in-healthy-indiana-plan-support-20-interim-evl-rpt-07062016.pdf ↩︎
  515. The Lewin Group, Healthy Indiana Plan 2.0: POWER Account Contribution Assessment, (The Lewin Group, prepared for the Indiana Family and Social Services Administration, March 2017), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/Healthy-Indiana-Plan-2/in-healthy-indiana-plan-support-20-POWER-acct-cont-assesmnt-03312017.pdf ↩︎
  516. Brad Wright et al., “Completion of Requirements in Iowa’s Medicaid Expansion Premium Disincentive Program, 2014–2015,” American Journal of Public Health 108, no. 2 (February 2018): 219-223, http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.304178 ↩︎
  517. Emily Zylla, Colin Planalp, Elizabeth Lukanen, and Lynn Blewett, Section 1115 Medicaid Expansion Waivers: Implementation Experiences, (Medicaid and CHIP Payment and Access Commission, February 2018), https://www.macpac.gov/publication/section-1115-medicaid-expansion-waivers-implementation-experiences/ ↩︎
  518. Shiho Kino and Ichiro Kawachi, “Can Health Literacy Boost Health Services Utilization in the Context of Expanded Access to Health Insurance?,” Health Education & Behavior Epub ahead of print (October 2019), https://doi.org/10.1177/1090198119875998 ↩︎
  519. Helmneh M. Sineshaw et al., “Association of Medicaid Expansion Under the Affordable Care Act With Stage at Diagnosis and Time to Treatment Initiation for Patients With Head and Neck Squamous Cell Carcinoma,” JAMA Otolaryngology–Head & Neck Surgery Epub ahead of print (January 2020), https://doi.org/10.1001/jamaoto.2019.4310 ↩︎
  520. Emanuel Eguia et al., “The Impact of the Affordable Care Act Medicaid Expansion on Vascular Surgery,” Annals of Vascular Surgery Epub ahead of print (January 2020), https://doi.org/10.1016/j.avsg.2020.01.006 ↩︎
  521. Jesse C. Baumgartner, Sara R. Collins, David C. Radley, and Susan L. Hayes, How the Affordable Care Act Has Narrowed Racial and Ethnic Disparities in Access to Health Care (The Commonwealth Fund, January 2020), https://www.commonwealthfund.org/publications/2020/jan/how-ACA-narrowed-racial-ethnic-disparities-access ↩︎
  522. Dennis McCarty, Yifan Gu, John W. McIlveen, and Bonnie K. Lind, “Medicaid Expansion and Treatment for Opioid Use Disorders in Oregon: An Interrupted Time-Series Analysis,” Addiction Science & Clinical Practice 14 (August 2019), https://doi.org/10.1186/s13722-019-0160-6 ↩︎
  523. Anna L. Goldman and Benjamin D. Sommers, “Among Low-Income Adults Enrolled In Medicaid, Churning Decreased After The Affordable Care Act,” Health Affairs 39, no. 1 (January 2020): 85-93, https://doi.org/10.1377/hlthaff.2019.00378 ↩︎
  524. Emanuel Eguia et al., “The Impact of the Affordable Care Act (ACA) Medicaid Expansion on Access to Minimally Invasive Surgical Care,” The American Journal of Surgery Epub ahead of print (July 2019), https://doi.org/10.1016/j.amjsurg.2019.07.003 ↩︎
  525. Afshin Ehsan et al., “Utilization of Left Ventricular Assist Devices in Vulnerable Adults Across Medicaid Expansion,” Journal of Surgical Research 243 (November 2019): 503-508, https://doi.org/10.1016/j.jss.2019.05.015 ↩︎
  526. Kevin N. Griffith, “Changes in Insurance Coverage and Access to Care for Young Adults in 2017,” Journal of Adolescent Health Epub ahead of print (July 2019), https://doi.org/10.1016/j.jadohealth.2019.05.020 ↩︎
  527. Jin Huang and Shirley L. Porterfield, “Changes in Health Insurance Coverage and Health Care Access as Teens with Disabilities Transition to Adulthood,” Disability and Health Journal 12, no. 4 (October 2019): 551-556, https://doi.org/10.1016/j.dhjo.2019.06.009 ↩︎
  528. Kelsie M. Gould et al., “Bariatric Surgery Among Vulnerable Populations: The Effect of the Affordable Care Act’s Medicaid Expansion,” Surgery 166, no. 5 (November 2019): 820-828, https://doi.org/10.1016/j.surg.2019.05.005 ↩︎
  529. Michael McCue, “The Impact of Medicaid Expansion on Medicaid Focused Insurers in California,” Inquiry: The Journal of Health Care Organization, Provision, and Financing 52 (July 2015), http://inq.sagepub.com/content/52/0046958015595960.full.pdf+html ↩︎
  530. Thomas C. Buchmueller, Helen G. Levy, and Robert G. Valletta, Medicaid Expansion and the Unemployed (National Bureau of Economic Research, Working Paper No. 26553, December 2019), http://www.nber.org/papers/w26553 ↩︎
  531. Jacqueline Fiore, The Impact of the Affordable Care Act’s Medicaid Expansion on Medicaid Spending by Health Care Service Category (Tulane University, July 2017), http://econ.tulane.edu/RePEc/pdf/tul1706.pdf ↩︎
  532. Emily Johnston, Andrea Strahan, Peter Joski, Anne Dunlop, and E. Kathleen Adams, “Impacts of the Affordable Care Act’s Medicaid Expansion on Women of Reproductive Age,” Women’s Health Issues, 28, no. 2 (February 2018), http://www.whijournal.com/article/S1049-3867(17)30242-6/pdf ↩︎
  533. Claire E. Margerison et al., “Impacts of Medicaid Expansion on Health Among Women of Reproductive Age,” American Journal of Preventive Medicine Epub ahead of print (November 2019), https://doi.org/10.1016/j.amepre.2019.08.019 ↩︎
  534. Elham Mahmoudi, Alicia Cohen, Jason Buxbaum, Caroline Richardson, and Wassim Tarraf, “Gaining Medicaid Coverage During ACA Implementation: Effects on Access to Care and Preventive Services,” Journal of Health Care for the Poor and Underserved 29, no. 4 (November 2018): 1472-1487, https://muse.jhu.edu/article/708253 ↩︎
  535. Stacey McMorrow, Jason Gates, Sharon Long, and Genevieve Kenney, “Medicaid Expansion Increased Coverage, Improved Affordability, and Reduced Psychological Distress for Low-Income Parents,” Health Affairs 36 no. 5 (May 2017): 808-818, https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1650 ↩︎
  536. Haley Moss, Laura Havrilesky, and Junzo Chino, “Insurance Coverage Among Women Diagnosed with a Gynecologic Malignancy Before and After Implementation of the Affordable Care Act,” Gynecologic Oncology 146, no. 3 (September 2017), https://www.ncbi.nlm.nih.gov/pubmed/28641821 ↩︎
  537. Susannah Gibbs et al., “Evaluating the Effect of Medicaid Expansion on Access to Preventive Reproductive Care for Women in Oregon,” Preventive Medicine Epub ahead of print (November 2019), https://doi.org/10.1016/j.ypmed.2019.105899 ↩︎
  538. Nadia Laniado, Avery R. Brow, Eric Tranby, and Victor M. Badner, “Trends in Non-Traumatic Dental Emergency Department Use in New York and New Jersey: A Look at Medicaid Expansion from Both Sides of the Hudson River,” Journal of Public Health Dentistry Epub ahead of print (October 2019), https://doi.org/10.1111/jphd.12343 ↩︎
  539. Thomas Selden, Brandy Lipton, and Sandra Decker, “Medicaid Expansion and Marketplace Eligibility Both Increased Coverage, With Trade-Offs in Access, Affordability,” Health Affairs 36 no. 12 (December 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0830 ↩︎
  540. Dahai Yue, Petra Rasmussen, and Ninez Ponce, “Racial/Ethnic Differential Effects of Medicaid Expansion on Health Care Access,” Health Services Research (February 2018), http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12834/abstract ↩︎
  541. Mark Clapp et al., “Association of Medicaid Expansion With Coverage and Access to Care for Pregnant Women,” Obstetrics & Gynecology 134, no. 5 (November 2019): 1066-1074, https://doi.org/10.1097/aog.0000000000003501 ↩︎
  542. Charles A. Daly et al., “The Effects of Medicaid Expansion on Triage and Regional Transfer After Upper-Extremity Trauma,” The Journal of Hand Surgery 44, no. 9 (September 2019): 720-727, https://doi.org/10.1016/j.jhsa.2019.05.020 ↩︎
  543. Yunwei Gai and John Marthinsen, “Medicaid Expansion, HIV Testing, and HIV-Related Risk Behaviors in the United States, 2010-2017,” American Journal of Public Health 109, no. 10 (October 2019): 1404-1412, https://doi.org/10.2105/ajph.2019.305220 ↩︎
  544. Huabin Luo, Zhuo Chen, Lei Xu, and Ronny Bell, “Health Care Access and Receipt of Clinical Diabetes Preventive Care for Working-Age Adults With Diabetes in States With and Without Medicaid Expansion: Results from the 2013 and 2015 BRFSS,” Journal of Public Health Management and Practice 25, no. 4 (July/August 2019): 34-43, https://doi.org/10.1097/phh.0000000000000832 ↩︎
  545. A. Taylor Kelley, Renuka Tipirneni, and Helen Levy, “Changes in Veterans’ Coverage and Access to Care Following the Affordable Care Act, 2011-2017,” American Journal of Public Health 109, no. 9 (September 2019): 1233-1235, https://doi.org/10.2105/ajph.2019.305160 ↩︎
  546. J. Travis Donahoe et al., “The Affordable Care Act Medicaid Expansion and Smoking Cessation Among Low-Income Smokers,” American Journal of Preventive Medicine 57, no. 6 (December 2019): 203-210, https://doi.org/10.1016/j.amepre.2019.07.004 ↩︎
  547. Hiroshi Gotanda, Gerald Kominski, and Yusuke Tsugawa, “Association Between the ACA Medicaid Expansions and Primary Care and Emergency Department Use During the First 3 Years,” Journal of General Internal Medicine Epub ahead of print (December 2019), https://doi.org/10.1007/s11606-019-05458-w ↩︎
  548. Evan M. Chen et al., “Association of the Affordable Care Act Medicaid Expansion with Dilated Eye Examinations among the United States Population with Diabetes,” Ophthalmology Epub ahead of print (September 2019), https://doi.org/10.1016/j.ophtha.2019.09.010 ↩︎
  549. Mark L. Diana et al., Louisiana Medicaid Expansion and Access to Care (Louisiana Department of Health, Prepared by Tulane University, July 2019), http://ldh.la.gov/assets/media/AccesstoCareReport20132018final.pdf ↩︎
  550. Ann-Marie Rosland et al., “Diagnosis and Care of Chronic Health Conditions Among Medicaid Expansion Enrollees: a Mixed-Methods Observational Study,” Journal of General Internal Medicine 34, no. 11 (November 2019): 2549-2558, https://doi.org/10.1007/s11606-019-05323-w ↩︎
  551. Chelsea L. Shover et al., “The Relationship of Medicaid Expansion to Psychiatric Comorbidity Care within Substance Use Disorder Treatment Programs,” Journal of Substance Abuse Treatment 105 (October 2019): 44-50, https://doi.org/10.1016/j.jsat.2019.07.012 ↩︎
  552. Sarah Miller and Laura Wherry, “Health and Access to Care During the First 2 Years of the ACA Medicaid Expansions,” The New England Journal of Medicine 376 no. 10 (March 2017), http://www.nejm.org/doi/full/10.1056/NEJMsa1612890 ↩︎
  553. Laura Wherry and Sarah Miller, “Early Coverage, Access, Utilization, and Health Effects Associated with the Affordable Care Act Medicaid Expansions: A Quasi-experimental Study,” Annals of Internal Medicine, Epub ahead of print (April 2016), http://annals.org/article.aspx?articleid=2513980 ↩︎
  554. Adele Shartzer, Sharon Long, and Nathaniel Anderson, “Access To Care and Affordability have Improved Following Affordable Care Act Implementation; Problems Remain,” Health Affairs (December 2015), http://content.healthaffairs.org/content/early/2015/12/14/hlthaff.2015.0755.full ↩︎
  555. Benjamin Sommers, Robert Blendon, and E. John Orav, “Both the ‘Private Option’ And Traditional Medicaid Expansions Improved Access To Care For Low-Income Adults,” Health Affairs 35, no. 1 (January 2016): 96-105, http://content.healthaffairs.org/content/35/1/96.abstract ↩︎
  556. Mark Olfson, Melanie Wall, Colleen Barry, Christine Mauro, and Ramin Mojtabai, “Impact Of Medicaid Expansion On Coverage And Treatment Of Low-Income Adults With Substance Use Disorders,” Health Affairs 37, no. 8 (August 2018), https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.0124 ↩︎
  557. Abeer Alharbi, M. Mahmud Khan, Ronnie Horner, Heather Brandt, and Cole Chapman, “Impact Of Medicaid Coverage Expansion Under The Affordable Care Act On Mammography And Pap Tests Utilization Among Low-Income Women,” PLOS One (April 2019), https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214886 ↩︎
  558. Jevay Grooms and Alberto Ortega, “Examining Medicaid Expansion and the Treatment of Substance Use Disorders,” American Economic Association Papers and Proceedings 109 (May 2019): 187-192, https://www.aeaweb.org/articles?id=10.1257/pandp.20191090 ↩︎
  559. Nathalie Huguet et al., “Cervical And Colorectal Cancer Screening Prevalence Before And After Affordable Care Act Medicaid Expansion,” Preventative Medicine (May 2019), https://doi.org/10.1016/j.ypmed.2019.05.003 ↩︎
  560. John Cawley, Aparna Soni, and Kosali Simon, “Third Year of Survey Data Shows Continuing Benefits of Medicaid Expansions for Low-Income Childless Adults in the U.S.,” Journal of General Internal Medicine 33, no. 9 (September 2018): 1495-1497, https://link.springer.com/article/10.1007%2Fs11606-018-4537-0 ↩︎
  561. Kosali Simon, Aparna Soni, and John Cawley, “The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions” Journal of Policy Analysis and Management 36, no. 2 (March 2017), https://onlinelibrary.wiley.com/doi/abs/10.1002/pam.21972 ↩︎
  562. Yasmin Zerhouni et al., “Effect of Medicaid Expansion on Colorectal Cancer Screening Rates,” Diseases of the Colon & Rectum 62, no. 1 (January 2019): 97-103, https://journals.lww.com/dcrjournal/Abstract/2019/01000/Effect_of_Medicaid_Expansion_on_Colorectal_Cancer.16.aspx ↩︎
  563. Carrie Fry and Benjamin Sommers, “Effect of Medicaid Expansion on Health Insurance Coverage and Access to Care Among Adults With Depression,” Psychiatric Services 69, no. 11 (November 2018), https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800181 ↩︎
  564. Xuesong Han, Robin Yabroff, Elizabeth Ward, Otis Brawley, and Ahmedin Jemal, “Comparison of Insurance Status and Diagnosis Stage Among Patients With Newly Diagnosed Cancer Before vs After Implementation of the Patient Protection and Affordable Care Act,” JAMA Oncology 4, no. 12 (August 2018): 1713-1720, https://jamanetwork.com/journals/jamaoncology/article-abstract/2697226 ↩︎
  565. Michael Hendryx and Juhua Luo, “Increased Cancer Screening for Low-income Adults Under the Affordable Care Act Medicaid Expansion,” Medical Care 56, no. 11 (November 2018): 944-949, https://www.ingentaconnect.com/content/wk/mcar/2018/00000056/00000011/art00009 ↩︎
  566. Brandy Lipton, Sandra Decker, and Benjamin Sommers, “The Affordable Care Act Appears to Have Narrowed Racial and Ethnic Disparities in Insurance Coverage and Access to Care Among Young Adults” Medical Care Research and Review 76, no.1 (April 2017): 32–55, https://www.ncbi.nlm.nih.gov/pubmed/29148341 ↩︎
  567. Stacey Fedewa, K. Robin Yabroff, Robert Smith, Ann Goding Sauer, Xuesong Han, and Ahmedin Jemal, “Changes in Breast and Colorectal Cancer Screening After Medicaid Expansion Under the Affordable Care Act,” American Journal of Preventive Medicine epub ahead of print (May 2019), https://www.sciencedirect.com/science/article/pii/S0749379719301163 ↩︎
  568. Tong Gan et al., “Impact of the Affordable Care Act on Colorectal Cancer Screening, Incidence, and Survival in Kentucky,” Journal of the American College of Surgeons 228, no. 4 (April 2019): 342-353.e1, https://www.journalacs.org/article/S1072-7515(19)30046-8/fulltext ↩︎
  569. Dmitry Tumin et al., “Medicaid Participation among Liver Transplant Candidates after the Affordable Care Act Medicaid Expansion” Journal of the American College of Surgeons 225, no. 2 (August 2017): 173-180.e2, https://www.journalacs.org/article/S1072-7515(17)30454-4/fulltext ↩︎
  570. Christina Andrews et al., “Medicaid Coverage In Substance Use Disorder Treatment After The Affordable Care Act,” Journal of Substance Abuse Treatment epub ahead of print (April 2019), https://www.sciencedirect.com/science/article/pii/S0740547218305750 ↩︎
  571. Manzilat Akande, Peter Minneci, Katherine Deans, Henry Xiang, Deena Chisolm, and Jennifer Cooper, “Effects Of Medicaid Expansion On Disparities In Trauma Care And Outcomes In Young Adults,” Journal of Surgical Research 228 (August 2018): 42-53, https://www.sciencedirect.com/science/article/pii/S0022480418301562 ↩︎
  572. Shiho Kino and Ichiro Kawachi, “The Impact Of ACA Medicaid Expansion On Socioeconomic Inequality In Health Care Services Utilization,” PLoS ONE 13, no. 2 (December 2018), https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209935 ↩︎
  573. James McDermott et al., “Affordable Care Act’s Medicaid Expansion and Use of Regionalized Surgery at High-Volume Hospitals,” Journal of the American College of Surgeons 227, no. 5 (November 2018): 507-520.e9, https://www.journalacs.org/article/S1072-7515(18)31993-8/abstract ↩︎
  574. Andrew Crocker et al., “Expansion Coverage And Preferential Utilization Of Cancer Surgery Among Racial And Ethnic Minorities And Low-Income Groups,” Surgery epub ahead of print (June 2019), https://www.surgjournal.com/article/S0039-6060(19)30198-9/fulltext ↩︎
  575. Emanuel Eguia et al., “The Impact of the Affordable Care Act (ACA) Medicaid Expansion on Access to Minimally Invasive Surgical Care,” The American Journal of Surgery Epub ahead of print (July 2019), https://doi.org/10.1016/j.amjsurg.2019.07.003 ↩︎
  576. Taressa K. Fraze et al., “Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals,” JAMA Network Open 2, no. 9 (September 2019), https://doi.org/10.1001/jamanetworkopen.2019.11514 ↩︎
  577. Kelsey L. Corrigan et al., “The Impact of the Patient Protection and Affordable Care Act on Insurance Coverage and Cancer-Directed Treatment in HIV-Infected Patients With Cancer in the United States,” Cancer (November 2019), https://doi.org/10.1002/cncr.32563 ↩︎
  578. Andrew Loehrer et al., “Association of the Affordable Care Act Medicaid Expansion with Access to and Quality of Care for Surgical Conditions,” Journal of the American Medical Association Surgery, epub ahead of print (January 2018), https://jamanetwork.com/journals/jamasurgery/article-abstract/2670459?redirect=true ↩︎
  579. Megan Cole, Omar Galarraga, Ira Wilson, Brad Wright, and Amal Trivedi, “At Federally Funded Health Centers, Medicaid Expansion was Associated with Improved Quality of Care,” Health Affairs 36 no. 1 (January 2017): 40-48, http://content.healthaffairs.org/content/36/1/40.full?sid=a3089120-6f4b-428b-bba8-5f005b444e19 ↩︎
  580. Megan Cole, Brad Wright, Ira Wilson, Omar Gallarraga, and Amal Trivedi, “Medicaid Expansion And Community Health Centers: Care Quality And Service Use Increased For Rural Patients” Health Affairs 37, no. 6 (June 2018), https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2017.1542 ↩︎
  581. Benjamin Sommers, Robert Blendon, E. John Orav, and Arnold Epstein, “Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance,” The Journal of the American Medical Association 176 no. 10 (October 2016): 1501-1509, http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2542420 ↩︎
  582. Benjamin Sommers, Bethany Maylone, Robert Blendon, E. John Orav, and Arnold Epstein, “Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults,” Health Affairs epub ahead of print (May 2017), http://content.healthaffairs.org/content/early/2017/05/15/hlthaff.2017.0293 ↩︎
  583. Hefei Wen, Kenton J. Johnston, Lindsay Allen, and Teresa M. Waters, “Medicaid Expansion Associated With Reductions In Preventable Hospitalizations,” Health Affairs 38, no. 11 (November 2019): 1845-1849, https://doi.org/10.1377/hlthaff.2019.00483 ↩︎
  584. Mohammad Eslami et al., “Impact of Medicaid Expansion of the Affordable Care on the Outcomes of Lower Extremity Bypass for Patients With Peripheral Artery Disease in the Vascular Quality Initiative Database,” Annals of Surgery 270, no. 4 (October 2019): 647-655, https://doi.org/10.1097/sla.0000000000003521 ↩︎
  585. John Scott et al., “Lifting the Burden: State Medicaid Expansion Reduces Financial Risk for the Injured,” Journal of Trauma and Acute Care Surgery Epub ahead of print (September 2019), https://doi.org/10.1097/ta.0000000000002493 ↩︎
  586. Gary Pickens et al., “Changes in Hospital Inpatient Utilization Following Health Care Reform,” Health Services Research epub ahead of print (June 2017), https://www.ncbi.nlm.nih.gov/pubmed/28664983 ↩︎
  587. Jeremy Holzmacher et al., “Association of Expanded Medicaid Coverage with Hospital Length of Stay After Injury,” JAMA Surgery published online (June 2017), https://www.ncbi.nlm.nih.gov/pubmed/28658482 ↩︎
  588. Andrew Admon, Thomas Valley, John Ayanian, Theodore Iwashyna, Colin Cooke, and Renuka Tipirneni, “Trends in Hospital Utilization After Medicaid Expansion,” Medical Care 57, no. 4 (April 2019): 312-317, https://journals.lww.com/lww-medicalcare/Abstract/publishahead/Brief_Report__Trends_in_Hospital_Utilization_After.98489.aspx ↩︎
  589. Cheryl Zogg et al., “Association of Medicaid Expansion With Access to Rehabilitative Care in Adult Trauma Patients,” JAMA Surgery epub ahead of print (January 2019), https://jamanetwork.com/journals/jamasurgery/article-abstract/2719270?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamasurg.2018.5177 ↩︎
  590. Andrew Admon, Michael Sjoding, Sarah Lyon, John Ayanian, Theodore Iwashyna, and Colin Cooke, “Medicaid Expansion and Mechanical Ventilation in Asthma, Chronic Obstructive Pulmonary Disease, and Heart Failure,” Annals of the American Thoracic Society epub ahead of print (February 2019), https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201811-777OC ↩︎
  591. Neal Bhutiani, Brian Harbrecht, Charles Scoggins, and Matthew Bozeman, “Evaluating The Early Impact Of Medicaid Expansion On Trends In Diagnosis And Treatment Of Benign Gallbladder Disease In Kentucky,” The American Journal of Surgery (January 2019), https://www.americanjournalofsurgery.com/article/S0002-9610(18)30894-8/fulltext ↩︎
  592. Manzilat Akande Peter Minneci, Katherine Deans, Henry Xiang, and Jennifer Cooper, “Association of Medicaid Expansion Under the Affordable Care Act With Outcomes and Access to Rehabilitation in Young Adult Trauma Patients,” JAMA Surgery 153, no. 8 (August 2018), https://jamanetwork.com/journals/jamasurgery/article-abstract/2682872?widget=personalizedcontent&previousarticle=2719270 ↩︎
  593. Manzilat Akande, Peter Minneci, Katherine Deans, Henry Xiang, Deena Chisolm, and Jennifer Cooper, “Effects Of Medicaid Expansion On Disparities In Trauma Care And Outcomes In Young Adults,” Journal of Surgical Research 228 (August 2018): 42-53, https://www.sciencedirect.com/science/article/pii/S0022480418301562 ↩︎
  594. Ramiro Manzano-Nunez et al., “Association of Medicaid Expansion Policy with Outcomes in Homeless Patients Requiring Emergency General Surgery,” World Journal of Surgery 43, no. 6 (June 2019): 1483-1489, https://link.springer.com/article/10.1007/s00268-019-04932-0 ↩︎
  595. De-Chih Lee, Leiyu Shi, and Hailun Liang, “Primary Care Utilization And Clinical Quality Performance: A Comparison Between Health Centres In Medicaid Expansion States And Non-Expansion States,” Journal of Health Services Research & Policy 24, no. 1 (January 2019): 19-24, https://journals.sagepub.com/doi/abs/10.1177/1355819618788592 ↩︎
  596. Jusung Lee et al., “The Impact of Medicaid Expansion on Diabetes Management,” Diabetes Care Epub ahead of print (October 2019), https://doi.org/10.2337/dc19-1173 ↩︎
  597. John A. Graves et al., “Medicaid Expansion Slowed Rates of Health Decline for Low-Income Adults in Southern States,” Health Affairs 39, no. 1 (January 2020): 67-76, https://doi.org/10.1377/hlthaff.2019.00929 ↩︎
  598. Renuka Tipirneni et al., “Association of Expanded Medicaid Coverage With Health and Job-Related Outcomes Among Enrollees With Behavioral Health Disorders,” Psychiatric Services Epub ahead of print (September 2019), https://doi.org/10.1176/appi.ps.201900179 ↩︎
  599. Susan Dorr Goold et al., “Primary Care, Health Promotion, and Disease Prevention with Michigan Medicaid Expansion,” Journal of General Internal Medicine Epub ahead of print (December 2019), https://doi.org/10.1007/s11606-019-05370-3 ↩︎
  600. Ann-Marie Rosland et al., “Diagnosis and Care of Chronic Health Conditions Among Medicaid Expansion Enrollees: a Mixed-Methods Observational Study,” Journal of General Internal Medicine 34, no. 11 (November 2019): 2549-2558, https://doi.org/10.1007/s11606-019-05323-w ↩︎
  601. Claire E. Margerison et al., “Impacts of Medicaid Expansion on Health Among Women of Reproductive Age,” American Journal of Preventive Medicine Epub ahead of print (November 2019), https://doi.org/10.1016/j.amepre.2019.08.019 ↩︎
  602. Renuka Tipirneni et al., “Changes in Health and Ability to Work Among Medicaid Expansion Enrollees: a Mixed Methods Study,” Journal of General Internal Medicine 34, no. 2 (February 2019): 272-280, https://link.springer.com/article/10.1007/s11606-018-4736-8 ↩︎
  603. Hyunjung Lee and Frank Porell, “The Effect of the Affordable Care Act Medicaid Expansion on Disparities in Access to Care and Health Status,” Medical Care Research and Review epub ahead of print (October 2018), https://journals.sagepub.com/doi/abs/10.1177/1077558718808709?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=mcrd ↩︎
  604. Benjamin Sommers, Bethany Maylone, Robert Blendon, E. John Orav, and Arnold Epstein, “Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults,” Health Affairs epub ahead of print (May 2017), http://content.healthaffairs.org/content/early/2017/05/15/hlthaff.2017.0293 ↩︎
  605. Benjamin Sommers, Robert Blendon, E. John Orav, and Arnold Epstein, “Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance,” The Journal of the American Medical Association 176 no. 10 (October 2016): 1501-1509, http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2542420 ↩︎
  606. Stacey McMorrow, Jason Gates, Sharon Long, and Genevieve Kenney, “Medicaid Expansion Increased Coverage, Improved Affordability, and Reduced Psychological Distress for Low-Income Parents,” Health Affairs 36 no. 5 (May 2017): 808-818, https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1650 ↩︎
  607. John Cawley, Aparna Soni, and Kosali Simon, “Third Year of Survey Data Shows Continuing Benefits of Medicaid Expansions for Low-Income Childless Adults in the U.S.,” Journal of General Internal Medicine 33, no. 9 (September 2018): 1495-1497, https://link.springer.com/article/10.1007%2Fs11606-018-4537-0 ↩︎
  608. Barbara DiPietro, Samantha Artiga, and Alexandra Gates, Early Impacts of the Medicaid Expansion for the Homeless Population (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, November 2014), http://kff.org/uninsured/issue-brief/early-impacts-of-the-medicaid-expansion-for-the-homeless-population/ ↩︎
  609. Kosali Simon, Aparna Soni, and John Cawley, “The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions” Journal of Policy Analysis and Management 36, no. 2 (March 2017), https://onlinelibrary.wiley.com/doi/abs/10.1002/pam.21972 ↩︎
  610. Tyler Winkelman and Virginia Chang, “Medicaid Expansion, Mental Health, and Access to Care Among Childless Adults With and Without Chronic Conditions,” Journal of General Internal Medicine epub ahead of print (November 2017), https://www.ncbi.nlm.nih.gov/pubmed/29181792 ↩︎
  611. The Ohio Department of Medicaid, 2018 Ohio Medicaid Group VIII Assessment: A Follow‐Up to the 2016 Ohio Medicaid Group VIII Assessment, (The Ohio Department of Medicaid, August 2018), https://medicaid.ohio.gov/Portals/0/Resources/Reports/Annual/Group-VIII-Final-Report.pdf ↩︎
  612. Susan Dorr Goold et al., “Primary Care Clinicians’ Views About the Impact of Medicaid Expansion in Michigan: A Mixed Methods Study,” Journal of General Internal Medicine 33, no. 8 (June 2018): 1307-1316, https://link.springer.com/article/10.1007/s11606-018-4487-6 ↩︎
  613. Tong Gan et al., “Impact of the Affordable Care Act on Colorectal Cancer Screening, Incidence, and Survival in Kentucky,” Journal of the American College of Surgeons 228, no. 4 (April 2019): 342-353.e1, https://www.journalacs.org/article/S1072-7515(19)30046-8/fulltext ↩︎
  614. Eric Charles et al., “Impact of Medicaid Expansion on Cardiac Surgery Volume and Outcomes,” The Annals of Thoracic Surgery (June 2017), http://www.annalsthoracicsurgery.org/article/S0003-4975(17)30552-0/pdf ↩︎
  615. Cheryl Zogg et al., “Impact of Affordable Care Act Insurance Expansion on Pre-Hospital Access to Care: Changes in Adult Perforated Appendix Admission Rates after Medicaid Expansion and the Dependent Coverage Provision,” Journal of the American College of Surgeons 228, no. 1 (January 2019): 29-43, https://www.journalacs.org/article/S1072-7515(18)32078-7/fulltext ↩︎
  616. Clare Brown et al., “Association of State Medicaid Expansion Status With Low Birth Weight and Preterm Birth” Journal of the American Medical Association 321, no. 16 (April 2019), https://jamanetwork.com/journals/jama/fullarticle/2731179 ↩︎
  617. Steffani Bailey et al., “Tobacco Cessation in Affordable Care Act Medicaid Expansion States Versus Non-expansion States,” Nicotine & Tobacco Research epub ahead of print (May 2019), https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntz087/5498071 ↩︎
  618. Jonathan Koma, Julie Donohue, Colleen Barry, Haiden Huskamp, and Marian Jarlenski, “Medicaid Coverage Expansions and Cigarette Smoking Cessation Among Low-Income Adults,” Medical Care 55, no. 12 (December 2017): 1023-1029, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688008/ ↩︎
  619. Sarah Miller, Sean Altekruse, Norman Johnson, and Laura R. Wherry, Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data (National Bureau of Economic Research, Working Paper No. 26081, July 2019), http://www.nber.org/papers/w26081 ↩︎
  620. Nicole Kravitz-Wirtz et al., “Association of Medicaid Expansion With Opioid Overdose Mortality in the United States,” JAMA Network Open 3, no. 1 (January 2020), https://doi.org/10.1001/jamanetworkopen.2019.19066 ↩︎
  621. Chintan Bhatt and Consuelo Beck-Sague, “Medicaid Expansion and Infant Mortality in the United States,” American Journal of Public Health 108, no. 4 (April 2018): 565-567, https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.304218 ↩︎
  622. Sameed Ahmed Khatana et al., “Association of Medicaid Expansion With Cardiovascular Mortality,” JAMA Cardiology 4, no. 7 (July 2019): 671-679, https://doi.org/10.1001/jamacardio.2019.1651 ↩︎
  623. Shailender Swaminathan, Benjamin Sommers, Rebecca Thorsness, Rajnish Mehrotra, Yoojin Lee, and Amal Trivedi, “Association of Medicaid Expansion With 1-Year Mortality Among Patients With End-Stage Renal Disease,” Journal of the American Medical Association (JAMA) 320, no. 21 (December 2018): 2242-2250, https://jamanetwork.com/journals/jama/fullarticle/2710505?guestAccessKey=ea3a8641-320b-4afd-b96e-dc59fbd90b20&utm_source=TrendMD&utm_medium=cpc&utm_campaign=J_Am_Med_TrendMD_1&utm_content=olf&utm_term=102518 ↩︎
  624. Emanuel Eguia et al., “The Impact of the Affordable Care Act (ACA) Medicaid Expansion on Access to Minimally Invasive Surgical Care,” The American Journal of Surgery Epub ahead of print (July 2019), https://doi.org/10.1016/j.amjsurg.2019.07.003 ↩︎
  625. Taressa K. Fraze et al., “Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals,” JAMA Network Open 2, no. 9 (September 2019), https://doi.org/10.1001/jamanetworkopen.2019.11514 ↩︎
  626. Kelsey L. Corrigan et al., “The Impact of the Patient Protection and Affordable Care Act on Insurance Coverage and Cancer-Directed Treatment in HIV-Infected Patients With Cancer in the United States,” Cancer (November 2019), https://doi.org/10.1002/cncr.32563 ↩︎
  627. Mohammad Eslami et al., “Impact of Medicaid Expansion of the Affordable Care on the Outcomes of Lower Extremity Bypass for Patients With Peripheral Artery Disease in the Vascular Quality Initiative Database,” Annals of Surgery 270, no. 4 (October 2019): 647-655, https://doi.org/10.1097/sla.0000000000003521 ↩︎
  628. Megan Cole, Brad Wright, Ira Wilson, Omar Gallarraga, and Amal Trivedi, “Medicaid Expansion And Community Health Centers: Care Quality And Service Use Increased For Rural Patients” Health Affairs 37, no. 6 (June 2018), https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2017.1542 ↩︎
  629. Benjamin Sommers, Bethany Maylone, Robert Blendon, E. John Orav, and Arnold Epstein, “Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults,” Health Affairs epub ahead of print (May 2017), http://content.healthaffairs.org/content/early/2017/05/15/hlthaff.2017.0293 ↩︎
  630. Rishi Wadhera et al., “Association of the Affordable Care Act’s Medicaid Expansion With Care Quality and Outcomes for Low-Income Patients Hospitalized With Heart Failure,” Circulation: Cardiovascular Quality and Outcomes 11, no. 7 (June 2018), https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.004729 ↩︎
  631. Rishi Wadhera et al., “Association of State Medicaid Expansion With Quality of Care and Outcomes for Low-Income Patients Hospitalized With Acute Myocardial Infarction,” JAMA Cardiology 4, no. 2 (January 2019): 120-127, https://jamanetwork.com/journals/jamacardiology/article-abstract/2720425?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamacardio.2018.4577 ↩︎
  632. Chima Ndumele, William Schpero, and Amal Trivedi, “Medicaid Expansion and Health Plan Quality in Medicaid Managed Care,” Health Services Research 53, no. 4, Part II (August 2018), https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.12814 ↩︎
  633. Megan Cole, Omar Galarraga, Ira Wilson, Brad Wright, and Amal Trivedi, “At Federally Funded Health Centers, Medicaid Expansion was Associated with Improved Quality of Care,” Health Affairs 36 no. 1 (January 2017): 40-48, http://content.healthaffairs.org/content/36/1/40.full?sid=a3089120-6f4b-428b-bba8-5f005b444e19 ↩︎
  634. De-Chih Lee, Leiyu Shi, and Hailun Liang, “Primary Care Utilization And Clinical Quality Performance: A Comparison Between Health Centres In Medicaid Expansion States And Non-Expansion States,” Journal of Health Services Research & Policy 24, no. 1 (January 2019): 19-24, https://journals.sagepub.com/doi/abs/10.1177/1355819618788592 ↩︎
  635. John Scott et al., “Lifting the Burden: State Medicaid Expansion Reduces Financial Risk for the Injured,” Journal of Trauma and Acute Care Surgery Epub ahead of print (September 2019), https://doi.org/10.1097/ta.0000000000002493 ↩︎
  636. Gary Pickens et al., “Changes in Hospital Inpatient Utilization Following Health Care Reform,” Health Services Research epub ahead of print (June 2017), https://www.ncbi.nlm.nih.gov/pubmed/28664983 ↩︎
  637. Jeremy Holzmacher et al., “Association of Expanded Medicaid Coverage with Hospital Length of Stay After Injury,” JAMA Surgery published online (June 2017), https://www.ncbi.nlm.nih.gov/pubmed/28658482 ↩︎
  638. Mary Anderson, Jeffrey Glasheen, and Debra Anoff, “Impact of State Medicaid Expansion Status on Length of Stay and In-Hospital Mortality for General Medicine Patients at US Academic Medical Centers,” Journal of Hospital Medicine Epub ahead of print (August 2016), http://onlinelibrary.wiley.com/wol1/doi/10.1002/jhm.2649/citedby ↩︎
  639. Andrew Admon, Thomas Valley, John Ayanian, Theodore Iwashyna, Colin Cooke, and Renuka Tipirneni, “Trends in Hospital Utilization After Medicaid Expansion,” Medical Care 57, no. 4 (April 2019): 312-317, https://journals.lww.com/lww-medicalcare/Abstract/publishahead/Brief_Report__Trends_in_Hospital_Utilization_After.98489.aspx ↩︎
  640. Andrew Admon, Michael Sjoding, Sarah Lyon, John Ayanian, Theodore Iwashyna, and Colin Cooke, “Medicaid Expansion and Mechanical Ventilation in Asthma, Chronic Obstructive Pulmonary Disease, and Heart Failure,” Annals of the American Thoracic Society epub ahead of print (February 2019), https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201811-777OC ↩︎
  641. Ehimare Akhabue, Lindsay Pool, Clyde Yancy, Philip Greenland, and Donald Lloyd-Jones, “Association of State Medicaid Expansion With Rate of Uninsured Hospitalizations for Major Cardiovascular Events, 2009-2014,” JAMA Network Open 1, no. 4 (August 2018), https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2698077 ↩︎
  642. Donald Likosky, Devraj Sukul, Milan Seth, Chang He, Hitlander Gurm, and Richard Prager, “The Association Between Medicaid Expansion and Cardiovascular Interventions: The Michigan Experience,” Journal of the American College of Cardiology 71, no. 9 (March 2018): 1050-1051, https://www.sciencedirect.com/science/article/pii/S0735109718300056?via%3Dihub ↩︎
  643. Neal Bhutiani, Brian Harbrecht, Charles Scoggins, and Matthew Bozeman, “Evaluating The Early Impact Of Medicaid Expansion On Trends In Diagnosis And Treatment Of Benign Gallbladder Disease In Kentucky,” The American Journal of Surgery (January 2019), https://www.americanjournalofsurgery.com/article/S0002-9610(18)30894-8/fulltext ↩︎
  644. Rishi Wadhera et al., “Association of the Affordable Care Act’s Medicaid Expansion With Care Quality and Outcomes for Low-Income Patients Hospitalized With Heart Failure,” Circulation: Cardiovascular Quality and Outcomes 11, no. 7 (June 2018), https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.004729 ↩︎
  645. Rishi Wadhera et al., “Association of State Medicaid Expansion With Quality of Care and Outcomes for Low-Income Patients Hospitalized With Acute Myocardial Infarction,” JAMA Cardiology 4, no. 2 (January 2019): 120-127, https://jamanetwork.com/journals/jamacardiology/article-abstract/2720425?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamacardio.2018.4577 ↩︎
  646. Manzilat Akande Peter Minneci, Katherine Deans, Henry Xiang, and Jennifer Cooper, “Association of Medicaid Expansion Under the Affordable Care Act With Outcomes and Access to Rehabilitation in Young Adult Trauma Patients,” JAMA Surgery 153, no. 8 (August 2018), https://jamanetwork.com/journals/jamasurgery/article-abstract/2682872?widget=personalizedcontent&previousarticle=2719270 ↩︎
  647. Manzilat Akande, Peter Minneci, Katherine Deans, Henry Xiang, Deena Chisolm, and Jennifer Cooper, “Effects Of Medicaid Expansion On Disparities In Trauma Care And Outcomes In Young Adults,” Journal of Surgical Research 228 (August 2018): 42-53, https://www.sciencedirect.com/science/article/pii/S0022480418301562 ↩︎
  648. Cheryl Zogg et al., “Association of Medicaid Expansion With Access to Rehabilitative Care in Adult Trauma Patients,” JAMA Surgery epub ahead of print (January 2019), https://jamanetwork.com/journals/jamasurgery/article-abstract/2719270?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamasurg.2018.5177 ↩︎
  649. Ramiro Manzano-Nunez et al., “Association of Medicaid Expansion Policy with Outcomes in Homeless Patients Requiring Emergency General Surgery,” World Journal of Surgery 43, no. 6 (June 2019): 1483-1489, https://link.springer.com/article/10.1007/s00268-019-04932-0 ↩︎
  650. Mark Clapp et al., “Association of Medicaid Expansion With Coverage and Access to Care for Pregnant Women,” Obstetrics & Gynecology 134, no. 5 (November 2019): 1066-1074, https://doi.org/10.1097/aog.0000000000003501 ↩︎
  651. John A. Graves et al., “Medicaid Expansion Slowed Rates of Health Decline for Low-Income Adults in Southern States,” Health Affairs 39, no. 1 (January 2020): 67-76, https://doi.org/10.1377/hlthaff.2019.00929 ↩︎
  652. Nicole Kravitz-Wirtz et al., “Association of Medicaid Expansion With Opioid Overdose Mortality in the United States,” JAMA Network Open 3, no. 1 (January 2020), https://doi.org/10.1001/jamanetworkopen.2019.19066 ↩︎
  653. James A. Swartz and Susanny J. Beltran, “Prescription Opioid Availability and Opioid Overdose-Related Mortality Rates in Medicaid Expansion and Non-Expansion States,” Addiction 114, no. 11 (November 2019): 2016-2025, https://doi.org/10.1111/add.14741 ↩︎
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  661. Sarah Miller and Laura Wherry, “Four Years Later: Insurance Coverage and Access to Care Continue to Diverge between ACA Medicaid Expansion and Non-Expansion States,” American Economic Association Papers and Proceedings 109 (May 2019): 327-333, https://www.aeaweb.org/articles?id=10.1257/pandp.20191046 ↩︎
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  667. Manzilat Akande, Peter Minneci, Katherine Deans, Henry Xiang, Deena Chisolm, and Jennifer Cooper, “Effects Of Medicaid Expansion On Disparities In Trauma Care And Outcomes In Young Adults,” Journal of Surgical Research 228 (August 2018): 42-53, https://www.sciencedirect.com/science/article/pii/S0022480418301562 ↩︎
  668. Hyunjung Lee and Frank Porell, “The Effect of the Affordable Care Act Medicaid Expansion on Disparities in Access to Care and Health Status,” Medical Care Research and Review epub ahead of print (October 2018), https://journals.sagepub.com/doi/abs/10.1177/1077558718808709?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=mcrd ↩︎
  669. John Cawley, Aparna Soni, and Kosali Simon, “Third Year of Survey Data Shows Continuing Benefits of Medicaid Expansions for Low-Income Childless Adults in the U.S.,” Journal of General Internal Medicine 33, no. 9 (September 2018): 1495-1497, https://link.springer.com/article/10.1007%2Fs11606-018-4537-0 ↩︎
  670. Kosali Simon, Aparna Soni, and John Cawley, “The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions” Journal of Policy Analysis and Management 36, no. 2 (March 2017), https://onlinelibrary.wiley.com/doi/abs/10.1002/pam.21972 ↩︎
  671. Nimish Valvi, Neomi Vin-Raviv, and Tomi Akinyemiju, “Current Smoking and Quit-Attempts Among US Adults Following Medicaid Expansion,” Preventive Medicine Reports epub ahead of print (June 2019), https://www.sciencedirect.com/science/article/pii/S2211335519300981 ↩︎
  672. Bernard Black, Alex Hollingsworth, Leticia Nunes, and Kosali Simon, The Effect of Health Insurance on Mortality: Power Analysis and What We Can Learn from the Affordable Care Act Coverage Expansions, (National Bureau of Economic Research, Working Paper Series No. 25568, February 2019), https://www.nber.org/papers/w25568 ↩︎
  673. Susan L. Averett, Julie K. Smith, and Yang Wang, “Medicaid Expansion and Opioid Deaths,” Health Economics 28, no. 12 (December 2019): 1491-1496, https://doi.org/10.1002/hec.3945 ↩︎
  674. Johanna Maclean and Brendan Saloner, The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act (National Bureau of Economic Research Working Paper No. 23342, April 2017), http://www.nber.org/papers/w23342.pdf ↩︎
  675. Mark L. Diana et al., Louisiana Medicaid Expansion and Access to Care (Louisiana Department of Health, Prepared by Tulane University, July 2019), http://ldh.la.gov/assets/media/AccesstoCareReport20132018final.pdf ↩︎
  676. Fredric Blavin, Impact of the Affordable Care Act’s Medicaid Expansion on Medicare Enrollees’ Access to Physician Services (Washington, DC: The Urban Institute, August 2019), https://www.urban.org/research/publication/effect-affordable-care-act-medicare-enrollees-access-physician-services ↩︎
  677. Jesse M. Hinde et al., “Increasing Access to Opioid Use Disorder Treatment: Assessing State Policies and the Evidence Behind Them,” Journal of Studies on Alcohol and Drugs 80, no. 6 (November 2019): 693-697, https://doi.org/10.15288/jsad.2019.80.693 ↩︎
  678. Angelica Meinhofer and Allison Witman, “The Role Of Health Insurance On Treatment For Opioid Use Disorders: Evidence From The Affordable Care Act Medicaid Expansion,” Journal of Health Economics 60 (June 2018): 177-197, https://www.sciencedirect.com/science/article/abs/pii/S0167629617311530 ↩︎
  679. Samantha Artiga, Robin Rudowitz, Jennifer Tolbert, Julia Paradise, and Melissa Majerol, Findings from the Field: Medicaid Delivery Systems and Access to Care in Four States in Year Three of the ACA (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, September 2016), http://kff.org/medicaid/issue-brief/findings-from-the-field-medicaid-delivery-systems-and-access-to-care-in-four-states-in-year-three-of-the-aca/ ↩︎
  680. Simon Basseyn, Brendan Saloner, Genevieve Kenney, Douglas Wissoker, Daniel Polsky, and Karin Rhodes, Primary Care Appointment Availability for Medicaid Patients: Comparing Traditional and Premium Assistance Plans, (Penn Leonard Davis Institute of Health Economics, July 2016), http://ldi.upenn.edu/brief/primary-care-appointment-availability-medicaid-patients-comparing-traditional-and-premium ↩︎
  681. Rachel Garfield, Elizabeth Hinton, Elizabeth Cornachione, and Cornelia Hall, Medicaid Managed Care Plans and Access to Care: Results from the Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans (Washington, DC: Kaiser Family Foundation, March 2018), https://modern.kff.org/medicaid/report/medicaid-managed-care-plans-and-access-to-care-results-from-the-kaiser-family-foundation-2017-survey-of-medicaid-managed-care-plans ↩︎
  682. Hannah Neprash, Anna Zink, Joshua Gray, and Katherine Hempstead, “Physicians’ Participation In Medicaid Increased Only Slightly Following Expansion” Health Affairs 37, no. 7 (July 2018), https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2017.1085 ↩︎
  683. Susan Dorr Goold et al., “Primary Care Clinicians’ Views About the Impact of Medicaid Expansion in Michigan: A Mixed Methods Study,” Journal of General Internal Medicine 33, no. 8 (June 2018): 1307-1316, https://link.springer.com/article/10.1007/s11606-018-4487-6 ↩︎
  684. Sara Rosenbaum, Jennifer Tolbert, Jessica Sharac, Peter Shin, Rachel Gunsalus, and Julia Zur, Community Health Centers: Growing Importance in a Changing Health Care System (Washington, DC: Kaiser Family Foundation, March 2018), https://modern.kff.org/medicaid/issue-brief/community-health-centers-growing-importance-in-a-changing-health-care-system/ ↩︎
  685. Hefei Wen, Adam S. Wilk, and Benjamin G. Druss, “Medicaid Acceptance by Psychiatrists Before and After Medicaid Expansion,” JAMA Psychiatry epub ahead of print (June 2019), https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2735109?resultClick=1 ↩︎
  686. Molly Candon et al., Primary Care Appointment Availability and the ACA Insurance Expansions (Philadelphia, PA: University of Pennsylvania Leonard Davis Institute of Health Economics, March 2017), https://ldi.upenn.edu/brief/primary-care-appointment-availability-and-aca-insurance-expansions ↩︎
  687. Benjamin Sommers, Robert Blendon, E. John Orav, and Arnold Epstein, “Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance,” The Journal of the American Medical Association 176 no. 10 (October 2016): 1501-1509, http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2542420 ↩︎
  688. Xinxin Han, Quian Luo, and Leighton Ku, “Medicaid Expansion and Grant Funding Increases Helped Improve Community Health Center Capacity,” Health Affairs 36 no. 1 (January 2017): 49-56, http://content.healthaffairs.org/content/36/1/49.full?sid=a3089120-6f4b-428b-bba8-5f005b444e19 ↩︎
  689. Nathalie Huguet et al., “Medicaid Expansion Produces Long-Term Impact on Insurance Coverage Rates in Community Health Centers,” Journal of Primary Care & Community Health epub ahead of print (May 2017), http://journals.sagepub.com/doi/full/10.1177/2150131917709403 ↩︎
  690. Josh Gray, Anna Zink, and Tony Dreyfus, Effects of the Affordable Care Act Through 2015, (athenaResearch and Robert Wood Johnson Foundation ACA View Report, March 2016), http://www.athenahealth.com/~/media/athenaweb/files/pdf/acaview_tracking_the_impact_of_health_care_reform ↩︎
  691. Josh Gray, Iyue Sung, and Stewart Richardson, Observations on the Affordable Care Act: 2014 (athenaResearch and Robert Wood Johnson Foundation ACA View Report, February 2015), http://www.athenahealth.com/~/media/athenaweb/files/pdf/acaview_year_end_2014.pdf ↩︎
  692. The Ohio Department of Medicaid, 2018 Ohio Medicaid Group VIII Assessment: A Follow‐Up to the 2016 Ohio Medicaid Group VIII Assessment, (The Ohio Department of Medicaid, August 2018), https://medicaid.ohio.gov/Portals/0/Resources/Reports/Annual/Group-VIII-Final-Report.pdf ↩︎
  693. MaryBeth Musumeci, Robin Rudowitz, Petry Ubri, and Elizabeth Hinton, An Early Look at Medicaid Expansion Waiver Implementation in Michigan and Indiana (Washington, DC: The Kaiser Family Foundation, January 2017), http://kff.org/medicaid/issue-brief/an-early-look-at-medicaid-expansion-waiver-implementation-in-michigan-and-indiana/ ↩︎
  694. Samantha Artiga, Jennifer Tolbert, and Robin Rudowitz, Year Two of the ACA Coverage Expansions: On-the-Ground Experiences from Five States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, June 2015), http://kff.org/health-reform/issue-brief/year-two-of-the-aca-coverage-expansions-on-the-ground-experiences-from-five-states/ ↩︎
  695. Government Accountability Office, Behavioral Health: Options for Low-Income Adults to Receive Treatment in Selected States (Washington, DC: Government Accountability Office, June 2015), http://www.gao.gov/assets/680/670894.pdf ↩︎
  696. Samantha Artiga and Robin Rudowitz, How Have State Medicaid Expansion Decisions Affected the Experiences of Low-Income Adults? Perspectives from Ohio, Arkansas, and Missouri (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, June 2015), http://kff.org/medicaid/issue-brief/how-have-state-medicaid-expansion-decisions-affected-the-experiences-of-low-income-adults-perspectives-from-ohio-arkansas-and-missouri/ ↩︎
  697. Peter Shin, Jessica Sharac, Julia Zur, Sara Rosenbaum, and Julia Paradise, Health Center Patient Trends, Enrollment Activities, and Service Capacity: Recent Experience in Medicaid Expansion and Non-Expansion States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, December 2015), http://kff.org/medicaid/issue-brief/health-center-patient-trends-enrollment-activities-and-service-capacity-recent-experience-in-medicaid-expansion-and-non-expansion-states/ ↩︎
  698. Renuka Tipirneni et al., “Primary Care Appointment Availability and Nonphysician Providers One Year After Medicaid Expansion,” The American Journal of Managed Care 22 no. 6 (June 2016): 427-431, http://www.ajmc.com/journals/issue/2016/2016-vol22-n6/primary-care-appointment-availability-and-nonphysician-providers-one-year-after-medicaid-expansion ↩︎
  699. Sara Collins, Munira Gunja, Michelle Doty, and Sophie Beutel, Americans’ Experiences with ACA Marketplace and Medicaid Coverage: Access to Care and Satisfaction (The Commonwealth Fund, May 2016), http://www.commonwealthfund.org/publications/issue-briefs/2016/may/aca-tracking-survey-access-to-care-and-satisfaction ↩︎
  700. Renuka Tipirneni et al., “Primary Care Appointment Availability For New Medicaid Patients Increased After Medicaid Expansion In Michigan,” Health Affairs (July 2015), http://content.healthaffairs.org/content/early/2015/07/15/hlthaff.2014.1425.full ↩︎
  701. De-Chih Lee, Leiyu Shi, and Hailun Liang, “Primary Care Utilization And Clinical Quality Performance: A Comparison Between Health Centres In Medicaid Expansion States And Non-Expansion States,” Journal of Health Services Research & Policy 24, no. 1 (January 2019): 19-24, https://journals.sagepub.com/doi/abs/10.1177/1355819618788592 ↩︎
  702. Adam M. Almaguer et al., “Do Geographic Region, Medicaid Status, and Academic Affiliation Affect Access to Care Among Medicaid and Privately Insured Total Hip Arthroplasty Patients?,” Journal of Arthroplasty 34, no. 12 (December 2019): 2866-2871, https://doi.org/10.1016/j.arth.2019.07.030 ↩︎
  703. Colleen M. Carey, Sarah Miller, and Laura R. Wherry, The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare, (National Bureau of Economic Research, Working Paper Series No. 25153, October 2018), https://www.nber.org/papers/w25153 ↩︎
  704. Carrie Fry and Benjamin Sommers, “Effect of Medicaid Expansion on Health Insurance Coverage and Access to Care Among Adults With Depression,” Psychiatric Services 69, no. 11 (November 2018), https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800181 ↩︎
  705. Thomas Selden, Brandy Lipton, and Sandra Decker, “Medicaid Expansion and Marketplace Eligibility Both Increased Coverage, With Trade-Offs in Access, Affordability,” Health Affairs 36 no. 12 (December 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0830 ↩︎
  706. Joseph Labrum et al., “Does Medicaid Insurance Confer Adequate Access to Adult Orthopaedic Care in the Era of the Patient Protection and Affordable Care Act?” Clinical Orthopaedics and Related Research 475 no. 6 (June 2017): 1527-1536, https://link.springer.com/article/10.1007%2Fs11999-017-5263-3 ↩︎
  707. Fredric Blavin, Impact of the Affordable Care Act’s Medicaid Expansion on Medicare Enrollees’ Access to Physician Services (Washington, DC: The Urban Institute, August 2019), https://www.urban.org/research/publication/effect-affordable-care-act-medicare-enrollees-access-physician-services ↩︎
  708. Renuka Tipirneni et al., “Primary Care Appointment Availability For New Medicaid Patients Increased After Medicaid Expansion In Michigan,” Health Affairs (July 2015), http://content.healthaffairs.org/content/early/2015/07/15/hlthaff.2014.1425.full ↩︎
  709. Jevay Grooms and Alberto Ortega, “Examining Medicaid Expansion and the Treatment of Substance Use Disorders,” American Economic Association Papers and Proceedings 109 (May 2019): 187-192, https://www.aeaweb.org/articles?id=10.1257/pandp.20191090 ↩︎
  710. Hefei Wen, Adam S. Wilk, and Benjamin G. Druss, “Medicaid Acceptance by Psychiatrists Before and After Medicaid Expansion,” JAMA Psychiatry epub ahead of print (June 2019), https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2735109?resultClick=1 ↩︎
  711. Nathalie Huguet et al., “Medicaid Expansion Produces Long-Term Impact on Insurance Coverage Rates in Community Health Centers,” Journal of Primary Care & Community Health epub ahead of print (May 2017), http://journals.sagepub.com/doi/full/10.1177/2150131917709403 ↩︎
  712. Megan Cole, Omar Galarraga, Ira Wilson, Brad Wright, and Amal Trivedi, “At Federally Funded Health Centers, Medicaid Expansion was Associated with Improved Quality of Care,” Health Affairs 36 no. 1 (January 2017): 40-48, http://content.healthaffairs.org/content/36/1/40.full?sid=a3089120-6f4b-428b-bba8-5f005b444e19 ↩︎
  713. Renuka Tipirneni et al., “Primary Care Appointment Availability and Nonphysician Providers One Year After Medicaid Expansion,” The American Journal of Managed Care 22 no. 6 (June 2016): 427-431, http://www.ajmc.com/journals/issue/2016/2016-vol22-n6/primary-care-appointment-availability-and-nonphysician-providers-one-year-after-medicaid-expansion ↩︎
  714. Benjamin Sommers, Bethany Maylone, Robert Blendon, E. John Orav, and Arnold Epstein, “Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults,” Health Affairs epub ahead of print (May 2017), http://content.healthaffairs.org/content/early/2017/05/15/hlthaff.2017.0293 ↩︎
  715. Hilary Barnes, Michael Richards, Matthew McHugh, and Grant Martsolf, “Rural And Nonrural Primary Care Physician Practices Increasingly Rely On Nurse Practitioners,” Health Affairs 37, no. 6 (June 2018), https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2017.1158 ↩︎
  716. Sarah Miller and Laura Wherry, “Health and Access to Care During the First 2 Years of the ACA Medicaid Expansions,” The New England Journal of Medicine 376 no. 10 (March 2017), http://www.nejm.org/doi/full/10.1056/NEJMsa1612890 ↩︎
  717. Jenny Nguyen, Nidharshan Anandasivam, Daniel Cooperman, Richard Pelker, and Daniel Wiznia, “Does Medicaid Insurance Provide Sufficient Access to Pediatric Orthopedic Care Under the Affordable Care Act?,” Global Pediatric Health epub ahead of print (February 2019), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6381430/ ↩︎
  718. Benjamin Sommers, Bethany Maylone, Robert Blendon, E. John Orav, and Arnold Epstein, “Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults,” Health Affairs epub ahead of print (May 2017), http://content.healthaffairs.org/content/early/2017/05/15/hlthaff.2017.0293 ↩︎
  719. Thomas Selden, Brandy Lipton, and Sandra Decker, “Medicaid Expansion and Marketplace Eligibility Both Increased Coverage, With Trade-Offs in Access, Affordability,” Health Affairs 36 no. 12 (December 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0830 ↩︎
  720. Samantha Artiga, Robin Rudowitz, Jennifer Tolbert, Julia Paradise, and Melissa Majerol, Findings from the Field: Medicaid Delivery Systems and Access to Care in Four States in Year Three of the ACA (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, September 2016), http://kff.org/medicaid/issue-brief/findings-from-the-field-medicaid-delivery-systems-and-access-to-care-in-four-states-in-year-three-of-the-aca/ ↩︎
  721. MaryBeth Musumeci, Robin Rudowitz, Petry Ubri, and Elizabeth Hinton, An Early Look at Medicaid Expansion Waiver Implementation in Michigan and Indiana (Washington, DC: The Kaiser Family Foundation, January 2017), http://kff.org/medicaid/issue-brief/an-early-look-at-medicaid-expansion-waiver-implementation-in-michigan-and-indiana/ ↩︎
  722. Samantha Artiga, Jennifer Tolbert, and Robin Rudowitz, Year Two of the ACA Coverage Expansions: On-the-Ground Experiences from Five States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, June 2015), http://kff.org/health-reform/issue-brief/year-two-of-the-aca-coverage-expansions-on-the-ground-experiences-from-five-states/ ↩︎
  723. Government Accountability Office, Behavioral Health: Options for Low-Income Adults to Receive Treatment in Selected States (Washington, DC: Government Accountability Office, June 2015), http://www.gao.gov/assets/680/670894.pdf ↩︎
  724. Samantha Artiga and Robin Rudowitz, How Have State Medicaid Expansion Decisions Affected the Experiences of Low-Income Adults? Perspectives from Ohio, Arkansas, and Missouri (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, June 2015), http://kff.org/medicaid/issue-brief/how-have-state-medicaid-expansion-decisions-affected-the-experiences-of-low-income-adults-perspectives-from-ohio-arkansas-and-missouri/ ↩︎
  725. Peter Shin, Jessica Sharac, Julia Zur, Sara Rosenbaum, and Julia Paradise, Health Center Patient Trends, Enrollment Activities, and Service Capacity: Recent Experience in Medicaid Expansion and Non-Expansion States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, December 2015), http://kff.org/medicaid/issue-brief/health-center-patient-trends-enrollment-activities-and-service-capacity-recent-experience-in-medicaid-expansion-and-non-expansion-states/ ↩︎
  726. Renuka Tipirneni et al., “Primary Care Appointment Availability and Nonphysician Providers One Year After Medicaid Expansion,” The American Journal of Managed Care 22 no. 6 (June 2016): 427-431, http://www.ajmc.com/journals/issue/2016/2016-vol22-n6/primary-care-appointment-availability-and-nonphysician-providers-one-year-after-medicaid-expansion ↩︎
  727. Renuka Tipirneni et al., “Primary Care Appointment Availability For New Medicaid Patients Increased After Medicaid Expansion In Michigan,” Health Affairs (July 2015), http://content.healthaffairs.org/content/early/2015/07/15/hlthaff.2014.1425.full ↩︎
  728. John Scott et al., “Lifting the Burden: State Medicaid Expansion Reduces Financial Risk for the Injured,” Journal of Trauma and Acute Care Surgery Epub ahead of print (September 2019), https://doi.org/10.1097/ta.0000000000002493 ↩︎
  729. Jesse C. Baumgartner, Sara R. Collins, David C. Radley, and Susan L. Hayes, How the Affordable Care Act Has Narrowed Racial and Ethnic Disparities in Access to Health Care (The Commonwealth Fund, January 2020), https://www.commonwealthfund.org/publications/2020/jan/how-ACA-narrowed-racial-ethnic-disparities-access ↩︎
  730. Xuesong Han et al., “Changes in Noninsurance and Care Unaffordability Among Cancer Survivors Following the Affordable Care Act,” Journal of the National Cancer Institute Epub ahead of print (November 2019), https://doi.org/10.1093/jnci/djz218 ↩︎
  731. Lindsay C. Kobayashi, Onur Altindag, Yulya Truskinovsky, and Lisa F. Berkman, “Effects of the Affordable Care Act Medicaid Expansion on Subjective Well-Being in the US Adult Population, 2010-2016,” American Journal of Public Health 109, no. 9 (September 2019): 1236-1242, https://doi.org/10.2105/ajph.2019.305164 ↩︎
  732. Kevin N. Griffith, “Changes in Insurance Coverage and Access to Care for Young Adults in 2017,” Journal of Adolescent Health Epub ahead of print (July 2019), https://doi.org/10.1016/j.jadohealth.2019.05.020 ↩︎
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  734. Jin Huang and Shirley L. Porterfield, “Changes in Health Insurance Coverage and Health Care Access as Teens with Disabilities Transition to Adulthood,” Disability and Health Journal 12, no. 4 (October 2019): 551-556, https://doi.org/10.1016/j.dhjo.2019.06.009 ↩︎
  735. Claire E. Margerison et al., “Impacts of Medicaid Expansion on Health Among Women of Reproductive Age,” American Journal of Preventive Medicine Epub ahead of print (November 2019), https://doi.org/10.1016/j.amepre.2019.08.019 ↩︎
  736. Kyle Caswell and Timothy Waidmann, The Affordable Care Act Medicaid Expansions and Personal Finance (Washington, DC: The Urban Institute, September 2017), https://www.urban.org/research/publication/affordable-care-act-medicaid-expansions-and-personal-finance ↩︎
  737. Stacey McMorrow, Genevieve Kenney, Sharon Long, and Jason Gates, “Marketplaces Helped Drive Coverage Gains in 2015; Affordability Problems Remained,” Health Affairs 35 no. 10 (October 2016): 1810-1815, http://content.healthaffairs.org/content/35/10/1810.full ↩︎
  738. Kenneth Brevoort, Daniel Grodzicki, and Martin Hackmann, Medicaid and Financial Health (National Bureau of Economic Research, Working Paper No. 24002, November 2017), http://www.nber.org/papers/w24002 ↩︎
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  740. Tyler Winkelman and Virginia Chang, “Medicaid Expansion, Mental Health, and Access to Care Among Childless Adults With and Without Chronic Conditions,” Journal of General Internal Medicine epub ahead of print (November 2017), https://www.ncbi.nlm.nih.gov/pubmed/29181792 ↩︎
  741. Dahai Yue, Petra Rasmussen, and Ninez Ponce, “Racial/Ethnic Differential Effects of Medicaid Expansion on Health Care Access,” Health Services Research (February 2018), http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12834/abstract ↩︎
  742. The Ohio Department of Medicaid, 2018 Ohio Medicaid Group VIII Assessment: A Follow‐Up to the 2016 Ohio Medicaid Group VIII Assessment, (The Ohio Department of Medicaid, August 2018), https://medicaid.ohio.gov/Portals/0/Resources/Reports/Annual/Group-VIII-Final-Report.pdf ↩︎
  743. Stacey McMorrow, Jason Gates, Sharon Long, and Genevieve Kenney, “Medicaid Expansion Increased Coverage, Improved Affordability, and Reduced Psychological Distress for Low-Income Parents,” Health Affairs 36 no. 5 (May 2017): 808-818, https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1650 ↩︎
  744. Sarah Miller, Luojia Hu, Robert Kaestner, Bhashkar Mazumder, and Ashley Wong, The ACA Medicaid Expansion in Michigan and Financial Health, (National Bureau of Economic Research, working paper no. 25053, September 2018), https://www.nber.org/papers/w25053.pdf ↩︎
  745. Shiho Kino and Ichiro Kawachi, “Can Health Literacy Boost Health Services Utilization in the Context of Expanded Access to Health Insurance?,” Health Education & Behavior Epub ahead of print (October 2019), https://doi.org/10.1177/1090198119875998 ↩︎
  746. Mark L. Diana et al., Louisiana Medicaid Expansion and Access to Care (Louisiana Department of Health, Prepared by Tulane University, July 2019), http://ldh.la.gov/assets/media/AccesstoCareReport20132018final.pdf ↩︎
  747. Ann-Marie Rosland et al., “Diagnosis and Care of Chronic Health Conditions Among Medicaid Expansion Enrollees: a Mixed-Methods Observational Study,” Journal of General Internal Medicine 34, no. 11 (November 2019): 2549-2558, https://doi.org/10.1007/s11606-019-05323-w ↩︎
  748. Carrie Fry and Benjamin Sommers, “Effect of Medicaid Expansion on Health Insurance Coverage and Access to Care Among Adults With Depression,” Psychiatric Services 69, no. 11 (November 2018), https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800181 ↩︎
  749. Hyunjung Lee and Frank Porell, “The Effect of the Affordable Care Act Medicaid Expansion on Disparities in Access to Care and Health Status,” Medical Care Research and Review epub ahead of print (October 2018), https://journals.sagepub.com/doi/abs/10.1177/1077558718808709?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=mcrd ↩︎
  750. Sarah Miller and Laura Wherry, “Four Years Later: Insurance Coverage and Access to Care Continue to Diverge between ACA Medicaid Expansion and Non-Expansion States,” American Economic Association Papers and Proceedings 109 (May 2019): 327-333, https://www.aeaweb.org/articles?id=10.1257/pandp.20191046 ↩︎
  751. Sunha Choi, Sungkyu Lee, and Jason Matejkowski, “The Effects of State Medicaid Expansion on Low-Income Individuals’ Access to Health Care: Multilevel Modeling,” Population Health Management epub ahead of print (September 2017), http://online.liebertpub.com/doi/abs/10.1089/pop.2017.0104 ↩︎
  752. Susan Hayes, Pamela Riley, David Radley, and Douglas McCarthy, Reducing Racial and Ethnic Disparities in Access to Care: Has the Affordable Care Act Made a Difference? (The Commonwealth Fund, August 2017), http://www.commonwealthfund.org/publications/issue-briefs/2017/aug/racial-ethnic-disparities-care ↩︎
  753. Susan Hayes, Sara Collins, David Radley, and Douglas McCarthy, What’s at Stake: States’ Progress on Health Coverage and Access to Care, 2013-2016 (The Commonwealth Fund, December 2017), http://www.commonwealthfund.org/publications/issue-briefs/2017/dec/states-progress-health-coverage-and-access ↩︎
  754. Emily Johnston, Andrea Strahan, Peter Joski, Anne Dunlop, and E. Kathleen Adams, “Impacts of the Affordable Care Act’s Medicaid Expansion on Women of Reproductive Age,” Women’s Health Issues, 28, no. 2 (February 2018), http://www.whijournal.com/article/S1049-3867(17)30242-6/pdf ↩︎
  755. Thomas Selden, Brandy Lipton, and Sandra Decker, “Medicaid Expansion and Marketplace Eligibility Both Increased Coverage, With Trade-Offs in Access, Affordability,” Health Affairs 36 no. 12 (December 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0830 ↩︎
  756. Kevin Griffith, Leigh Evans, and Jacob Bor, “The Affordable Care Act Reduced Socioeconomic Disparities in Health Care Access,” Health Affairs 36 no. 8 (August 2017), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0083 ↩︎
  757. Sharon Long, Lea Bart, Michael Karpman, Adele Shartzer, and Stephen Zuckerman, “Sustained Gains in Coverage, Access, and Affordability Under the ACA: A 2017 Update,” Health Affairs 36 no. 9 (September 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0798 ↩︎
  758. Benjamin Sommers, Bethany Maylone, Robert Blendon, E. John Orav, and Arnold Epstein, “Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults,” Health Affairs epub ahead of print (May 2017), http://content.healthaffairs.org/content/early/2017/05/15/hlthaff.2017.0293 ↩︎
  759. Bryce Ward and Brandon Bridge, The Economic Impact of Medicaid Expansion in Montana: Updated Findings (Bureau of Business and Economic Research, January 2019), https://mthcf.org/wp-content/uploads/2019/01/Economic-Impact-of-MedEx-in-MT_1.28.19-FINAL.pdf ↩︎
  760. Ameen Barghi, Hugo Torres, Nancy Kressin, and Danny McCormick, “Coverage and Access for Americans with Cardiovascular Disease or Risk Factors After the ACA: a Quasi-experimental Study,” Journal of General Internal Medicine epub ahead of print (June 2019), https://link.springer.com/article/10.1007%2Fs11606-019-05108-1 ↩︎
  761. Sarah Miller and Laura Wherry, “Health and Access to Care During the First 2 Years of the ACA Medicaid Expansions,” The New England Journal of Medicine 376 no. 10 (March 2017), http://www.nejm.org/doi/full/10.1056/NEJMsa1612890 ↩︎
  762. Sara Collins, Munira Gunja, Michelle Doty, and Sophie Beutel, Americans’ Experiences with ACA Marketplace and Medicaid Coverage: Access to Care and Satisfaction (The Commonwealth Fund, May 2016), http://www.commonwealthfund.org/publications/issue-briefs/2016/may/aca-tracking-survey-access-to-care-and-satisfaction ↩︎
  763. Joseph Benitez, Liza Creel, and J’Aime Jennings, “Kentucky’s Medicaid Expansion Showing Early Promise on Coverage and Access to Care,” Health Affairs (February 2016), http://content.healthaffairs.org/content/early/2016/02/16/hlthaff.2015.1294 ↩︎
  764. Benjamin Sommers, Robert Blendon, and E. John Orav, “Both the ‘Private Option’ And Traditional Medicaid Expansions Improved Access To Care For Low-Income Adults,” Health Affairs 35, no. 1 (January 2016): 96-105, http://content.healthaffairs.org/content/35/1/96.abstract ↩︎
  765. Samantha Artiga and Robin Rudowitz, How Have State Medicaid Expansion Decisions Affected the Experiences of Low-Income Adults? Perspectives from Ohio, Arkansas, and Missouri (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, June 2015), http://kff.org/medicaid/issue-brief/how-have-state-medicaid-expansion-decisions-affected-the-experiences-of-low-income-adults-perspectives-from-ohio-arkansas-and-missouri/ ↩︎
  766. John Cawley, Aparna Soni, and Kosali Simon, “Third Year of Survey Data Shows Continuing Benefits of Medicaid Expansions for Low-Income Childless Adults in the U.S.,” Journal of General Internal Medicine 33, no. 9 (September 2018): 1495-1497, https://link.springer.com/article/10.1007%2Fs11606-018-4537-0 ↩︎
  767. Aaron Sojourner and Ezra Golberstein, “Medicaid Expansion Reduced Unpaid Medical Debt and Increased Financial Satisfaction,” Health Affairs (July 2017), https://www.healthaffairs.org/do/10.1377/hblog20170724.061160/full/ ↩︎
  768. Frederic Blavin, Michael Karpman, Genevieve Kenney, and Benjamin Sommers, “Medicaid Versus Marketplace Coverage for Near-Poor Adults: Effects on Out-Of-Pocket Spending and Coverage,” Health Affairs 37 no. 2 (January 2018), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.1166 ↩︎
  769. Sherry Glied, Ougni Chakraborty, and Therese Russo, How Medicaid Expansion Affected Out-of-Pocket Health Care Spending for Low-Income Families (The Commonwealth Fund, August 2017), http://www.commonwealthfund.org/publications/issue-briefs/2017/aug/medicaid-expansion-out-of-pocket-spending-low-income ↩︎
  770. Benjamin Sommers, Robert Blendon, E. John Orav, and Arnold Epstein, “Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance,” The Journal of the American Medical Association 176 no. 10 (October 2016): 1501-1509, http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2542420 ↩︎
  771. Andrew Mulcahy, Christine Eibner, and Kenneth Finegold, “Gaining Coverage Through Medicaid Or Private Insurance Increased Prescription Use and Lowered Out-Of-Pocket Spending,” Health Affairs 35, no. 9 (September 2016), http://content.healthaffairs.org/content/early/2016/08/16/hlthaff.2016.0091.full ↩︎
  772. Anna Goldman, Steffie Woolhandler, and David Himmelstein, “Out-of-pocket Spending and Premium Contributions After Implementation of the Affordable Care Act,” Journal of the American Medical Association epub ahead of print (January 2018), https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2669908 ↩︎
  773. Helen Levy, Thomas Buchmueller, and Sayeh Nikpay, “The Impact of Medicaid Expansion on Household Consumption,” Eastern Economic Journal 45, no. 1 (January 2019): 34-57, https://link.springer.com/article/10.1057/s41302-018-0124-7 ↩︎
  774. Sarah Miller and Laura Wherry, “Four Years Later: Insurance Coverage and Access to Care Continue to Diverge between ACA Medicaid Expansion and Non-Expansion States,” American Economic Association Papers and Proceedings 109 (May 2019): 327-333, https://www.aeaweb.org/articles?id=10.1257/pandp.20191046 ↩︎
  775. Kenneth Brevoort, Daniel Grodzicki, and Martin Hackmann, Medicaid and Financial Health (National Bureau of Economic Research, Working Paper No. 24002, November 2017), http://www.nber.org/papers/w24002 ↩︎
  776. Kyle Caswell and Timothy Waidmann, The Affordable Care Act Medicaid Expansions and Personal Finance (Washington, DC: The Urban Institute, September 2017), https://www.urban.org/research/publication/affordable-care-act-medicaid-expansions-and-personal-finance ↩︎
  777. Sharon Long, Lea Bart, Michael Karpman, Adele Shartzer, and Stephen Zuckerman, “Sustained Gains in Coverage, Access, and Affordability Under the ACA: A 2017 Update,” Health Affairs 36 no. 9 (September 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0798 ↩︎
  778. Aaron Sojourner and Ezra Golberstein, “Medicaid Expansion Reduced Unpaid Medical Debt and Increased Financial Satisfaction,” Health Affairs (July 2017), https://www.healthaffairs.org/do/10.1377/hblog20170724.061160/full/ ↩︎
  779. Thomas Selden, Brandy Lipton, and Sandra Decker, “Medicaid Expansion and Marketplace Eligibility Both Increased Coverage, With Trade-Offs in Access, Affordability,” Health Affairs 36 no. 12 (December 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0830 ↩︎
  780. Benjamin Sommers, Bethany Maylone, Robert Blendon, E. John Orav, and Arnold Epstein, “Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults,” Health Affairs epub ahead of print (May 2017), http://content.healthaffairs.org/content/early/2017/05/15/hlthaff.2017.0293 ↩︎
  781. Stacey McMorrow, Jason Gates, Sharon Long, and Genevieve Kenney, “Medicaid Expansion Increased Coverage, Improved Affordability, and Reduced Psychological Distress for Low-Income Parents,” Health Affairs 36 no. 5 (May 2017): 808-818, https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1650 ↩︎
  782. Benjamin Sommers, Robert Blendon, E. John Orav, and Arnold Epstein, “Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance,” The Journal of the American Medical Association 176 no. 10 (October 2016): 1501-1509, http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2542420 ↩︎
  783. Sarah Miller and Laura Wherry, “Health and Access to Care During the First 2 Years of the ACA Medicaid Expansions,” The New England Journal of Medicine 376 no. 10 (March 2017), http://www.nejm.org/doi/full/10.1056/NEJMsa1612890 ↩︎
  784. Sarah Miller, Luojia Hu, Robert Kaestner, Bhashkar Mazumder, and Ashley Wong, The ACA Medicaid Expansion in Michigan and Financial Health, (National Bureau of Economic Research, working paper no. 25053, September 2018), https://www.nber.org/papers/w25053.pdf ↩︎
  785. The Ohio Department of Medicaid, 2018 Ohio Medicaid Group VIII Assessment: A Follow‐Up to the 2016 Ohio Medicaid Group VIII Assessment, (The Ohio Department of Medicaid, August 2018), https://medicaid.ohio.gov/Portals/0/Resources/Reports/Annual/Group-VIII-Final-Report.pdf ↩︎
  786. Sarah Miller, Luojia Hu, Robert Kaestner, Bhashkar Mazumder, and Ashley Wong, The ACA Medicaid Expansion in Michigan and Financial Health, (National Bureau of Economic Research, working paper no. 25053, September 2018), https://www.nber.org/papers/w25053.pdf ↩︎
  787. Gracie Himmelstein, “Effect of the Affordable Care Act’s Medicaid Expansions on Food Security, 2010-2016,” American Journal of Public Health 109, no. 9 (September 2019): 1243-1248, https://doi.org/10.2105/ajph.2019.305168 ↩︎
  788. Sanders Korenman, Dahlia K. Remler, and Rosemary T. Hyson, “Medicaid Expansions and Poverty: Comparing Supplemental and Health-Inclusive Poverty Measures,” Social Service Review 93, no. 3 (September 2019): 429-483, https://doi.org/10.1086/705319 ↩︎
  789. Naomi Zewde and Christopher Wimer, “Antipoverty Impact Of Medicaid Growing With State Expansions Over Time,” Health Affairs 38, no. 1 (January 2019), https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05155 ↩︎
  790. Kenneth Brevoort, Daniel Grodzicki, and Martin Hackmann, Medicaid and Financial Health (National Bureau of Economic Research, Working Paper No. 24002, November 2017), http://www.nber.org/papers/w24002 ↩︎
  791. Kyle Caswell and Timothy Waidmann, The Affordable Care Act Medicaid Expansions and Personal Finance (Washington, DC: The Urban Institute, September 2017), https://www.urban.org/research/publication/affordable-care-act-medicaid-expansions-and-personal-finance ↩︎
  792. Aaron Sojourner and Ezra Golberstein, “Medicaid Expansion Reduced Unpaid Medical Debt and Increased Financial Satisfaction,” Health Affairs (July 2017), https://www.healthaffairs.org/do/10.1377/hblog20170724.061160/full/ ↩︎
  793. Luojia Hu, Robert Kaestenr, Bhashkar Mazumder, Sarah Miller, and Ashley Wong, “The Effect of the Affordable Care Act Medicaid Expansions on Financial Wellbeing,” Journal of Public Economics 163 (July 2018): 99-112, https://www.sciencedirect.com/science/article/abs/pii/S0047272718300707 ↩︎
  794. Sarah Miller, Luojia Hu, Robert Kaestner, Bhashkar Mazumder, and Ashley Wong, The ACA Medicaid Expansion in Michigan and Financial Health, (National Bureau of Economic Research, working paper no. 25053, September 2018), https://www.nber.org/papers/w25053.pdf ↩︎
  795. The Ohio Department of Medicaid, 2018 Ohio Medicaid Group VIII Assessment: A Follow‐Up to the 2016 Ohio Medicaid Group VIII Assessment, (The Ohio Department of Medicaid, August 2018), https://medicaid.ohio.gov/Portals/0/Resources/Reports/Annual/Group-VIII-Final-Report.pdf ↩︎
  796. Gracie Himmelstein, “Effect of the Affordable Care Act’s Medicaid Expansions on Food Security, 2010-2016,” American Journal of Public Health 109, no. 9 (September 2019): 1243-1248, https://doi.org/10.2105/ajph.2019.305168 ↩︎
  797. Naomi Zewde and Christopher Wimer, “Antipoverty Impact Of Medicaid Growing With State Expansions Over Time,” Health Affairs 38, no. 1 (January 2019), https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05155 ↩︎
  798. Sanders Korenman, Dahlia K. Remler, and Rosemary T. Hyson, “Medicaid Expansions and Poverty: Comparing Supplemental and Health-Inclusive Poverty Measures,” Social Service Review 93, no. 3 (September 2019): 429-483, https://doi.org/10.1086/705319 ↩︎
  799. Naomi Zewde, Erica Eliason, Heidi Allen, and Tal Gross, “The Effects of the ACA Medicaid Expansion on Nationwide Home Evictions and Eviction-Court Initiations: United States, 2000-2016,” American Journal of Public Health 109, no. 10 (October 2019): 1379-1383, https://doi.org/10.2105/ajph.2019.305230 ↩︎
  800. Sarah Miller, Luojia Hu, Robert Kaestner, Bhashkar Mazumder, and Ashley Wong, The ACA Medicaid Expansion in Michigan and Financial Health, (National Bureau of Economic Research, working paper no. 25053, September 2018), https://www.nber.org/papers/w25053.pdf ↩︎
  801. Luojia Hu, Robert Kaestenr, Bhashkar Mazumder, Sarah Miller, and Ashley Wong, “The Effect of the Affordable Care Act Medicaid Expansions on Financial Wellbeing,” Journal of Public Economics 163 (July 2018): 99-112, https://www.sciencedirect.com/science/article/abs/pii/S0047272718300707 ↩︎
  802. Kenneth Brevoort, Daniel Grodzicki, and Martin Hackmann, Medicaid and Financial Health (National Bureau of Economic Research, Working Paper No. 24002, November 2017), http://www.nber.org/papers/w24002 ↩︎
  803. Aaron Sojourner and Ezra Golberstein, “Medicaid Expansion Reduced Unpaid Medical Debt and Increased Financial Satisfaction,” Health Affairs (July 2017), https://www.healthaffairs.org/do/10.1377/hblog20170724.061160/full/ ↩︎
  804. Kyle Caswell and Timothy Waidmann, The Affordable Care Act Medicaid Expansions and Personal Finance (Washington, DC: The Urban Institute, September 2017), https://www.urban.org/research/publication/affordable-care-act-medicaid-expansions-and-personal-finance ↩︎
  805. Sarah Miller, Luojia Hu, Robert Kaestner, Bhashkar Mazumder, and Ashley Wong, The ACA Medicaid Expansion in Michigan and Financial Health, (National Bureau of Economic Research, working paper no. 25053, September 2018), https://www.nber.org/papers/w25053.pdf ↩︎
  806. Xuesong Han et al., “Changes in Noninsurance and Care Unaffordability Among Cancer Survivors Following the Affordable Care Act,” Journal of the National Cancer Institute Epub ahead of print (November 2019), https://doi.org/10.1093/jnci/djz218 ↩︎
  807. Kevin Griffith, Leigh Evans, and Jacob Bor, “The Affordable Care Act Reduced Socioeconomic Disparities in Health Care Access,” Health Affairs 36 no. 8 (August 2017), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0083 ↩︎
  808. Shiho Kino and Ichiro Kawachi, “The Impact Of ACA Medicaid Expansion On Socioeconomic Inequality In Health Care Services Utilization,” PLoS ONE 13, no. 2 (December 2018), https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209935 ↩︎
  809. Susan Hayes, Sara Collins, David Radley, and Douglas McCarthy, What’s at Stake: States’ Progress on Health Coverage and Access to Care, 2013-2016 (The Commonwealth Fund, December 2017), http://www.commonwealthfund.org/publications/issue-briefs/2017/dec/states-progress-health-coverage-and-access ↩︎
  810. Susan Hayes, Pamela Riley, David Radley, and Douglas McCarthy, Reducing Racial and Ethnic Disparities in Access to Care: Has the Affordable Care Act Made a Difference? (The Commonwealth Fund, August 2017), http://www.commonwealthfund.org/publications/issue-briefs/2017/aug/racial-ethnic-disparities-care ↩︎
  811. Aaron Sojourner and Ezra Golberstein, “Medicaid Expansion Reduced Unpaid Medical Debt and Increased Financial Satisfaction,” Health Affairs (July 2017), https://www.healthaffairs.org/do/10.1377/hblog20170724.061160/full/ ↩︎
  812. Naomi Zewde, Erica Eliason, Heidi Allen, and Tal Gross, “The Effects of the ACA Medicaid Expansion on Nationwide Home Evictions and Eviction-Court Initiations: United States, 2000-2016,” American Journal of Public Health 109, no. 10 (October 2019): 1379-1383, https://doi.org/10.2105/ajph.2019.305230 ↩︎
  813. Jesse C. Baumgartner, Sara R. Collins, David C. Radley, and Susan L. Hayes, How the Affordable Care Act Has Narrowed Racial and Ethnic Disparities in Access to Health Care (The Commonwealth Fund, January 2020), https://www.commonwealthfund.org/publications/2020/jan/how-ACA-narrowed-racial-ethnic-disparities-access ↩︎
  814. A. Taylor Kelley, Renuka Tipirneni, and Helen Levy, “Changes in Veterans’ Coverage and Access to Care Following the Affordable Care Act, 2011-2017,” American Journal of Public Health 109, no. 9 (September 2019): 1233-1235, https://doi.org/10.2105/ajph.2019.305160 ↩︎
  815. Xuesong Han et al., “Changes in Noninsurance and Care Unaffordability Among Cancer Survivors Following the Affordable Care Act,” Journal of the National Cancer Institute Epub ahead of print (November 2019), https://doi.org/10.1093/jnci/djz218 ↩︎
  816. Thomas C. Buchmueller, Helen G. Levy, and Robert G. Valletta, Medicaid Expansion and the Unemployed (National Bureau of Economic Research, Working Paper No. 26553, December 2019), http://www.nber.org/papers/w26553 ↩︎
  817. Kevin N. Griffith, “Changes in Insurance Coverage and Access to Care for Young Adults in 2017,” Journal of Adolescent Health Epub ahead of print (July 2019), https://doi.org/10.1016/j.jadohealth.2019.05.020 ↩︎
  818. Jin Huang and Shirley L. Porterfield, “Changes in Health Insurance Coverage and Health Care Access as Teens with Disabilities Transition to Adulthood,” Disability and Health Journal 12, no. 4 (October 2019): 551-556, https://doi.org/10.1016/j.dhjo.2019.06.009 ↩︎
  819. Sanders Korenman, Dahlia K. Remler, and Rosemary T. Hyson, “Medicaid Expansions and Poverty: Comparing Supplemental and Health-Inclusive Poverty Measures,” Social Service Review 93, no. 3 (September 2019): 429-483, https://doi.org/10.1086/705319 ↩︎
  820. Jean M. Abraham, Anne B. Royalty, and Coleman Drake, “The Impact of Medicaid Expansion on Employer Provision of Health Insurance,” International Journal of Health Economics and Management 19, no. 3-4 (December 2019): 317-340, https://doi.org/10.1007/s10754-018-9256-x ↩︎
  821. Thomas Selden, Brandy Lipton, and Sandra Decker, “Medicaid Expansion and Marketplace Eligibility Both Increased Coverage, With Trade-Offs in Access, Affordability,” Health Affairs 36 no. 12 (December 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0830 ↩︎
  822. Sarah Miller and Laura Wherry, “Health and Access to Care During the First 2 Years of the ACA Medicaid Expansions,” The New England Journal of Medicine 376 no. 10 (March 2017), http://www.nejm.org/doi/full/10.1056/NEJMsa1612890 ↩︎
  823. Joseph Benitez, Liza Creel, and J’Aime Jennings, “Kentucky’s Medicaid Expansion Showing Early Promise on Coverage and Access to Care,” Health Affairs (February 2016), http://content.healthaffairs.org/content/early/2016/02/16/hlthaff.2015.1294 ↩︎
  824. Laura Wherry and Sarah Miller, “Early Coverage, Access, Utilization, and Health Effects Associated with the Affordable Care Act Medicaid Expansions: A Quasi-experimental Study,” Annals of Internal Medicine, Epub ahead of print (April 2016), http://annals.org/article.aspx?articleid=2513980 ↩︎
  825. Adele Shartzer, Sharon Long, and Nathaniel Anderson, “Access To Care and Affordability have Improved Following Affordable Care Act Implementation; Problems Remain,” Health Affairs (December 2015), http://content.healthaffairs.org/content/early/2015/12/14/hlthaff.2015.0755.full ↩︎
  826. Benjamin Sommers, Munira Gunja, Kenneth Finegold, and Thomas Musco, “Changes in Self-Reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act,” The Journal of the American Medical Association 314 no. 4 (July 2015): 366-374, http://jama.jamanetwork.com/article.aspx?articleid=2411283&resultClick=3 ↩︎
  827. Kenneth Brevoort, Daniel Grodzicki, and Martin Hackmann, Medicaid and Financial Health (National Bureau of Economic Research, Working Paper No. 24002, November 2017), http://www.nber.org/papers/w24002 ↩︎
  828. Aaron Sojourner and Ezra Golberstein, “Medicaid Expansion Reduced Unpaid Medical Debt and Increased Financial Satisfaction,” Health Affairs (July 2017), https://www.healthaffairs.org/do/10.1377/hblog20170724.061160/full/ ↩︎
  829. Stacey McMorrow, Jason Gates, Sharon Long, and Genevieve Kenney, “Medicaid Expansion Increased Coverage, Improved Affordability, and Reduced Psychological Distress for Low-Income Parents,” Health Affairs 36 no. 5 (May 2017): 808-818, https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1650 ↩︎
  830. Luojia Hu, Robert Kaestenr, Bhashkar Mazumder, Sarah Miller, and Ashley Wong, “The Effect of the Affordable Care Act Medicaid Expansions on Financial Wellbeing,” Journal of Public Economics 163 (July 2018): 99-112, https://www.sciencedirect.com/science/article/abs/pii/S0047272718300707 ↩︎
  831. Hyunjung Lee and Frank Porell, “The Effect of the Affordable Care Act Medicaid Expansion on Disparities in Access to Care and Health Status,” Medical Care Research and Review epub ahead of print (October 2018), https://journals.sagepub.com/doi/abs/10.1177/1077558718808709?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=mcrd ↩︎
  832. Helen Levy, Thomas Buchmueller, and Sayeh Nikpay, “The Impact of Medicaid Expansion on Household Consumption,” Eastern Economic Journal 45, no. 1 (January 2019): 34-57, https://link.springer.com/article/10.1057/s41302-018-0124-7 ↩︎
  833. Helen Levy et al., “Macroeconomic Feedback Effects of Medicaid Expansion: Evidence from Michigan,” Journal of Health Politics, Policy and Law Epub ahead of print (October 2019), https://doi.org/10.1215/03616878-7893555 ↩︎
  834. James A. Richardson, Jared J. Llorens, and Roy L. Heidelberg. Medicaid Expansion and the Louisiana Economy, 2018 and 2019 (Louisiana Department of Health, Prepared by Louisiana State University, August 2019), http://ldh.la.gov/assets/media/3and4.2019FinalReportMedicaidExpansionstudy.pdf ↩︎
  835. James Richardson, Jared Llorens, and Roy Heidelberg, Medicaid Expansion and the Louisiana Economy (Louisiana Department of Health, March 2018), http://gov.louisiana.gov/assets/MedicaidExpansion/MedicaidExpansionStudy.pdf ↩︎
  836. Bryce Ward and Brandon Bridge, The Economic Impact of Medicaid Expansion in Montana: Updated Findings (Bureau of Business and Economic Research, January 2019), https://mthcf.org/wp-content/uploads/2019/01/Economic-Impact-of-MedEx-in-MT_1.28.19-FINAL.pdf ↩︎
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  839. Louisiana Department of Health, Medicaid Expansion 2016/17 (Baton Rouge, Louisiana Department of Health, June 2017), http://dhh.louisiana.gov/assets/HealthyLa/Resources/MdcdExpnAnnlRprt_2017_WEB.pdf ↩︎
  840. April Grady, Deborah Bachrach, and Patti Boozang, Medicaid’s Role in the Delivery and Payment of Substance Use Disorder Services in Montana, (Manatt Health, March 2017), http://mthcf.org/wp-content/uploads/2017/03/Medicaid-Role-in-Substance-Use-Disorder-Services-in-Montana_Final.pdf ↩︎
  841. The Colorado Health Foundation, Assessing the Economic and Budgetary Impact of Medicaid Expansion in Colorado, (The Colorado Health Foundation, March 2016), https://www.coloradohealth.org/sites/default/files/documents/2017-01/Medicaid_ExecutiveSummary_ONLINE.pdf ↩︎
  842. Lee A. Reynis, Economic and Fiscal Impacts of the Medicaid Expansion in New Mexico, (The University of New Mexico Bureau of Business and Economic Research, February 2016), http://bber.unm.edu/media/publications/Medicaid_Expansion_Final2116R.pdf ↩︎
  843. Benjamin Sommers and Jonathan Gruber, “Federal Funding Insulated State Budgets From Increased Spending Related To Medicaid Expansion,” Health Affairs epub ahead of print (April 2017), https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2016.1666 ↩︎
  844. Abby Evans, John Folkemer, Joel Menges, Amira Mouna, Nick Pantaleo, Emily Ricci, and Poornima Sigh, Assessment of Medicaid Expansion and Reform, Initial Analysis (The Menges Group, January 2016), https://alaskamentalhealthtrust.org/wp-content/uploads/2018/08/HandOut-MedicaidExpansionAndReformInitialAnalysis-011516-TheMengesGroup.pdf ↩︎
  845. Chris Brown and John Bennett, Economic Impacts of the Arkansas Private Option (Regional Economic Models, Inc., August 2015), http://www.arkhospitals.org/Misc.%20Files/August2015APOEconomicImpacts.pdf ↩︎
  846. Deborah Bachrach, Patricia Boozang, Avi Herring, and Dori Glanz Reyneri, States Expanding Medicaid See Significant Budget Savings and Revenue Gains, (Manatt Health Solutions, prepared by the Robert Wood Johnson Foundation’s State Health Reform Assistance Network, March 2016), http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2016/rwjf419097 ↩︎
  847. Stan Dorn, Norton Francis, Laura Snyder, and Robin Rudowitz, The Effects of the Medicaid Expansion on State Budgets: An Early Look in Select States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, March 2015), http://kff.org/medicaid/issue-brief/the-effects-of-the-medicaid-expansion-on-state-budgets-an-early-look-in-select-states/ ↩︎
  848. Deloitte Development LLC, Commonwealth of Kentucky Medicaid Expansion Report, (Deloitte Development LLC, February 2015), http://jointhehealthjourney.com/images/uploads/channel-files/Kentucky_Medicaid_Expansion_One-Year_Study_FINAL.pdf ↩︎
  849. Robin Rudowitz, Laura Snyder, and Vernon K. Smith, Medicaid Enrollment and Spending Growth: FY 2015 & 2016 (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, October 2015), https://modern.kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2015-2016/ ↩︎
  850. Robin Rudowitz, Elizabeth Hinton, and Larisa Antonisse, Medicaid Enrollment and Spending Growth: FY 2018 & 2019 (Washington, DC: Kaiser Family Foundation, October 2018), https://modern.kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2018-2019/ ↩︎
  851. Robin Rudowitz, Elizabeth Hinton, Maria Diaz, Madeline Guth, and Marina Tian, Medicaid Enrollment and Spending Growth: FY 2019 & 2020 (Washington, DC: Kaiser Family Foundation, October 2019), https://modern.kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2019-2020/ ↩︎
  852. Micah Hartman et al., “National Health Care Spending in 2016: Spending and Enrollment Growth Slow After Initial Coverage Expansions,” Health Affairs epub ahead of print (December 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.1299 ↩︎
  853. Jacqueline Fiore, The Impact of the Affordable Care Act’s Medicaid Expansion on Medicaid Spending by Health Care Service Category (Tulane University, July 2017), http://econ.tulane.edu/RePEc/pdf/tul1706.pdf ↩︎
  854. Vikki Wachino and Samantha Artiga, How Connecting Justice-Involved Individuals to Medicaid Can Help Address the Opioid Epidemic (Washington, DC: Kaiser Family Foundation, June 2019), https://modern.kff.org/medicaid/issue-brief/how-connecting-justice-involved-individuals-to-medicaid-can-help-address-the-opioid-epidemic/ ↩︎
  855. Aaron McNay, Amy Watson, Barbara Wagner, and Chris Bradley, Montana Medicaid and Montana Employers (Montana Department of Revenue and Montana Department of Labor & Industry, January 2019), http://lmi.mt.gov/Portals/193/Publications/LMI-Pubs/Special%20Reports%20and%20Studies/MT-Medicaid_Report.pdf ↩︎
  856. Benjamin Sommers and Jonathan Gruber, “Federal Funding Insulated State Budgets From Increased Spending Related To Medicaid Expansion,” Health Affairs epub ahead of print (April 2017), http://content.healthaffairs.org/content/early/2017/04/10/hlthaff.2016.1666.full ↩︎
  857. Louisiana Department of Health, Medicaid Expansion 2016/17 (Baton Rouge, Louisiana Department of Health, June 2017), http://dhh.louisiana.gov/assets/HealthyLa/Resources/MdcdExpnAnnlRprt_2017_WEB.pdf ↩︎
  858. James Richardson, Jared Llorens, and Roy Heidelberg, Medicaid Expansion and the Louisiana Economy (Louisiana Department of Health, March 2018), http://gov.louisiana.gov/assets/MedicaidExpansion/MedicaidExpansionStudy.pdf ↩︎
  859. James A. Richardson, Jared J. Llorens, and Roy L. Heidelberg. Medicaid Expansion and the Louisiana Economy, 2018 and 2019 (Louisiana Department of Health, Prepared by Louisiana State University, August 2019), http://ldh.la.gov/assets/media/3and4.2019FinalReportMedicaidExpansionstudy.pdf ↩︎
  860. Manatt Health, Medicaid Expansion: How It Affects Montana’s State Budget, Economy, and Residents (Montana Healthcare Foundation, prepared by Manatt Health, June 2018), https://mthcf.org/wp-content/uploads/2018/06/Manatt-MedEx_FINAL_6.1.18.pdf ↩︎
  861. Aaron McNay, Amy Watson, Barbara Wagner, and Chris Bradley, Montana Medicaid and Montana Employers (Montana Department of Revenue and Montana Department of Labor & Industry, January 2019), http://lmi.mt.gov/Portals/193/Publications/LMI-Pubs/Special%20Reports%20and%20Studies/MT-Medicaid_Report.pdf ↩︎
  862. Helen Levy et al., “Macroeconomic Feedback Effects of Medicaid Expansion: Evidence from Michigan,” Journal of Health Politics, Policy and Law Epub ahead of print (October 2019), https://doi.org/10.1215/03616878-7893555 ↩︎
  863. Qiwei He and Scott Barkowski, “The Effect of Health Insurance on Crime: Evidence from the Affordable Care Act Medicaid Expansion,” Health Economics Epub ahead of print (January 2020): 261-277, https://doi.org/10.1002/hec.3977 ↩︎
  864. Jesse M. Hinde et al., “Increasing Access to Opioid Use Disorder Treatment: Assessing State Policies and the Evidence Behind Them,” Journal of Studies on Alcohol and Drugs 80, no. 6 (November 2019): 693-697, https://doi.org/10.15288/jsad.2019.80.693 ↩︎
  865. April Grady, Deborah Bachrach, and Patti Boozang, Medicaid’s Role in the Delivery and Payment of Substance Use Disorder Services in Montana, (Manatt Health, March 2017), http://mthcf.org/wp-content/uploads/2017/03/Medicaid-Role-in-Substance-Use-Disorder-Services-in-Montana_Final.pdf ↩︎
  866. Jacob Vogler, Access to Health Care and Criminal Behavior: Short-Run Evidence from the ACA Medicaid Expansions (University of Illinois at Urbana-Champaign, November 2017), https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3042267 ↩︎
  867. Vikki Wachino and Samantha Artiga, How Connecting Justice-Involved Individuals to Medicaid Can Help Address the Opioid Epidemic (Washington, DC: Kaiser Family Foundation, June 2019), https://modern.kff.org/medicaid/issue-brief/how-connecting-justice-involved-individuals-to-medicaid-can-help-address-the-opioid-epidemic/ ↩︎
  868. Deborah Bachrach, Patricia Boozang, Avi Herring, and Dori Glanz Reyneri, States Expanding Medicaid See Significant Budget Savings and Revenue Gains, (Manatt Health Solutions, prepared by the Robert Wood Johnson Foundation’s State Health Reform Assistance Network, March 2016), http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2016/rwjf419097 ↩︎
  869. Stan Dorn, Norton Francis, Laura Snyder, and Robin Rudowitz, The Effects of the Medicaid Expansion on State Budgets: An Early Look in Select States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, March 2015), http://kff.org/medicaid/issue-brief/the-effects-of-the-medicaid-expansion-on-state-budgets-an-early-look-in-select-states/ ↩︎
  870. Lee A. Reynis, Economic and Fiscal Impacts of the Medicaid Expansion in New Mexico, (The University of New Mexico Bureau of Business and Economic Research, February 2016), http://bber.unm.edu/media/publications/Medicaid_Expansion_Final2116R.pdf ↩︎
  871. Deloitte Development LLC, Commonwealth of Kentucky Medicaid Expansion Report, (Deloitte Development LLC, February 2015), http://jointhehealthjourney.com/images/uploads/channel-files/Kentucky_Medicaid_Expansion_One-Year_Study_FINAL.pdf ↩︎
  872. Abby Evans, John Folkemer, Joel Menges, Amira Mouna, Nick Pantaleo, Emily Ricci, and Poornima Sigh, Assessment of Medicaid Expansion and Reform, Initial Analysis (The Menges Group, January 2016), https://alaskamentalhealthtrust.org/wp-content/uploads/2018/08/HandOut-MedicaidExpansionAndReformInitialAnalysis-011516-TheMengesGroup.pdf ↩︎
  873. Johanna Maclean and Brendan Saloner, “The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act,” Journal of Policy Analysis and Management 38, no. 2 (2019): 366-393, https://www.ncbi.nlm.nih.gov/pubmed/30882195 ↩︎
  874. Mark Duggan, Atul Gupta, and Emilie Jackson, The Impact of the Affordable Care Act: Evidence from California’s Hospital Sector (National Bureau of Economic Research, working paper no. 25488, January 2019), https://www.nber.org/papers/w25488.pdf ↩︎
  875. Amanda Abraham et al., “Changes in State Technical Assistance Priorities and Block Grant Funds for Addiction After ACA Implementation,” American Journal of Public Health epub ahead of print (May 2019), https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2019.305052 ↩︎
  876. Aparna Soni, Marguerite Burns, Laura Dague, and Kosali Simon, “Medicaid Expansion and State Trends in Supplemental Security Income Program Participation,” Health Affairs 36 no. 8, (August 2017): 1485-1488, http://content.healthaffairs.org/content/36/8/1485.full?sid=982b20c0-0a17-4dc4-a35a-b0302d4ec289 ↩︎
  877. Paul Jacobs, Genevieve Kenney, and Thomas Selden, “Newly Eligible Enrollees In Medicaid Spend Less And Use Less Care Than Those Previously Eligible,” Health Affairs 36, no. 9 (September 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0252 ↩︎
  878. David Lassman et al., “Health Spending by State 1991-2014: Measuring Per Capita Spending by Payers and Programs,” Health Affairs epub ahead of print (June 2017), http://content.healthaffairs.org/content/early/2017/06/13/hlthaff.2017.0416 ↩︎
  879. Stephan R. Lindner et al., “Health Care Expenditures Among Adults With Diabetes After Oregon’s Medicaid Expansion,” Diabetes Care Epub ahead of print (December 2019), https://doi.org/10.2337/dc19-1343 ↩︎
  880. Laura Snyder, Katherine Young, Robin Rudowitz, and Rachel Garfield, Medicaid Expansion Spending and Enrollment in Context: An Early Look at CMS Claims Data for 2014 (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, January 2016), http://kff.org/medicaid/issue-brief/medicaid-expansion-spending-and-enrollment-in-context-an-early-look-at-cms-claims-data-for-2014/ ↩︎
  881. Heather Holderness et al., “Where Do Oregon Medicaid Enrollees Seek Outpatient Care Post-Affordable Care Act Medicaid Expansion?,” Medical Care 57, no. 10 (October 2019): 788-794, https://doi.org/10.1097/mlr.0000000000001189 ↩︎
  882. Christian Wolfe, Kathryn Rennie, and Christopher Truffer, 2017 Actuarial Report on the Financial Outlook for Medicaid (Office of the Actuary, Centers for Medicare and Medicaid Services, September 2018), https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/MedicaidReport2017.pdf ↩︎
  883. The Colorado Health Institute, Medicaid Expansion in Colorado: An Analysis of Enrollment, Costs and Benefits—and How They Exceeded Expectations (The Colorado Health Institute, May 2016), http://www.coloradohealthinstitute.org/uploads/postfiles/MK_Expansion_Report.pdf ↩︎
  884. Pennsylvania Department of Human Services, Medicaid Expansion Report, (Pennsylvania Department of Human Services, January 2017), http://www.dhs.pa.gov/cs/groups/webcontent/documents/document/c_257436.pdf ↩︎
  885. Laura Snyder, Katherine Young, Robin Rudowitz, and Rachel Garfield, Medicaid Expansion Spending and Enrollment in Context: An Early Look at CMS Claims Data for 2014 (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, January 2016), http://kff.org/medicaid/issue-brief/medicaid-expansion-spending-and-enrollment-in-context-an-early-look-at-cms-claims-data-for-2014/ ↩︎
  886. Paul Jacobs, Genevieve Kenney, and Thomas Selden, “Newly Eligible Enrollees In Medicaid Spend Less And Use Less Care Than Those Previously Eligible,” Health Affairs 36, no. 9 (September 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0252 ↩︎
  887. David Lassman et al., “Health Spending by State 1991-2014: Measuring Per Capita Spending by Payers and Programs,” Health Affairs epub ahead of print (June 2017), http://content.healthaffairs.org/content/early/2017/06/13/hlthaff.2017.0416 ↩︎
  888. Aditi Sen and Thomas DeLeire, The Effect of Medicaid Expansion on Marketplace Premiums (Office of the Assistant Secretary for Planning and Evaluation, August 2016), https://aspe.hhs.gov/sites/default/files/pdf/206761/McaidExpMktplcPrem.pdf ↩︎
  889. Aditi Sen and Thomas DeLeire, “How Does Expansion Of Public Health Insurance Affect Risk Pools And Premiums In The Market For Private Health Insurance? Evidence From Medicaid And The Affordable Care Act Marketplaces,” Health Economics 27 (July 2018): 1877–1903, https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.3809 ↩︎
  890. Ashley Semanskee, Cynthia Cox, and Larry Levitt, Data Note: Effect of State Decisions on State Risk Scores (Kaiser Family Foundation, October 2016), https://modern.kff.org/health-reform/issue-brief/data-note-effect-of-state-decisions-on-state-risk-scores/ ↩︎
  891. Jocelyn Guyer, Naomi Shine, MaryBeth Musumeci, and Robin Rudowitz, A Look at the Private Option in Arkansas (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, August 2015), http://kff.org/medicaid/issue-brief/a-look-at-the-private-option-in-arkansas/ ↩︎
  892. Bela Gorman and Jenn Smagula, 2016 Actuarial Analysis of NH Premium Assistance Program, (Gorman Actuarial, Inc., August 2017), https://www.nh.gov/insurance/reports/documents/08-28-17-ga-nh-pap-analysis-final.pdf ↩︎
  893. Hefei Wen, Kenton J. Johnston, Lindsay Allen, and Teresa M. Waters, “Medicaid Expansion Associated With Reductions In Preventable Hospitalizations,” Health Affairs 38, no. 11 (November 2019): 1845-1849, https://doi.org/10.1377/hlthaff.2019.00483 ↩︎
  894. Alexander T. Janke, Shooshan Danagoulian, Arjun K. Venkatesh, and Phillip D. Levy, “Medicaid Expansion and Resource Utilization in the Emergency Department,” The American Journal of Emergency Medicine Epub ahead of print (January 2020), https://doi.org/10.1016/j.ajem.2019.12.050 ↩︎
  895. Hawazin W. Elani, Ichiro Kawachi, and Benjamin D. Sommers, “Changes in Emergency Department Dental Visits after Medicaid Expansion,” Health Services Research Epub ahead of print (January 2020), https://doi.org/10.1111/1475-6773.13261 ↩︎
  896. Emanuel Eguia et al., “The Impact of the Affordable Care Act Medicaid Expansion on Vascular Surgery,” Annals of Vascular Surgery Epub ahead of print (January 2020), https://doi.org/10.1016/j.avsg.2020.01.006 ↩︎
  897. Mark Clapp et al., “Association of Medicaid Expansion With Coverage and Access to Care for Pregnant Women,” Obstetrics & Gynecology 134, no. 5 (November 2019): 1066-1074, https://doi.org/10.1097/aog.0000000000003501 ↩︎
  898. Charles A. Daly et al., “The Effects of Medicaid Expansion on Triage and Regional Transfer After Upper-Extremity Trauma,” The Journal of Hand Surgery 44, no. 9 (September 2019): 720-727, https://doi.org/10.1016/j.jhsa.2019.05.020 ↩︎
  899. John Scott et al., “Lifting the Burden: State Medicaid Expansion Reduces Financial Risk for the Injured,” Journal of Trauma and Acute Care Surgery Epub ahead of print (September 2019), https://doi.org/10.1097/ta.0000000000002493 ↩︎
  900. Craig Garthwaite et al., All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act (National Bureau of Economic Research, Working Paper No. 26289, September 2019), http://www.nber.org/papers/w26289 ↩︎
  901. Shannon McConville, Maria Raven, Sarah Sabbagh, and Renee Hsia, “Frequent Emergency Department Users: A Statewide Comparison Before And After Affordable Care Act Implementation,” Health Affairs 37, no. 6, (June 2018), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0784 ↩︎
  902. Rahul Ladhania, Amelia Haviland, Arvind Venkat, Rahul Telang, and Jesse Pines, “The Effect of Medicaid Expansion on the Nature of New Enrollees’ Emergency Department Use,” Medical Care Research and Review epub ahead of print (May 2019), https://journals.sagepub.com/doi/abs/10.1177/1077558719848270 ↩︎
  903. Beatrice D. Probst, Luther Walls, Michael Cirone, and Talar Markossian, “Examining the Effect of the Affordable Care Act on Two Illinois Emergency Departments,” Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health 20, no. 5 (September 2019): 710-716, https://doi.org/10.5811/westjem.2019.6.41943 ↩︎
  904. Kurt Gillis, Physicians’ Patient Mix – A Snapshot from the 2016 Benchmark Survey and Changes Associated with the ACA (American Medical Association, October 2017), https://www.ama-assn.org/sites/default/files/media-browser/public/health-policy/PRP-2017-physician-benchmark-survey-patient-mix.pdf ↩︎
  905. Seth Freedman, Sayeh Nikpay, Aaron Carroll, and Kosali Simon, “Changes in inpatient payer-mix and hospitalizations following Medicaid expansion: Evidence from all-capture hospital discharge data,” PLoS ONE 12 no. 9 (September 2017), http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0183616 ↩︎
  906. Allen Dobson, Joan DaVanzo, Randy Haught, and Phap Hoa Luu, Comparing the Affordable Care Act’s Financial Impact on Safety-Net Hospitals in States that Expanded Medicaid and Those That Did Not (The Commonwealth Fund, November 2017), http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2017/nov/dobson_impact_medicaid_expanion_safety_net_hosps_ib.pdf ↩︎
  907. Richard Lindrooth, Marcelo Perraillon, Rose Hardy, and Gregory Tung, “Understanding the Relationship Between Medicaid Expansions and Hospital Closures,” Health Affairs epub ahead of print (January 2018), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0976 ↩︎
  908. Heather Angier et al., “Uninsured Primary Care Visit Disparities under the Affordable Care Act,” Annals of Family Medicine, 15 no. 5 (September 2017): 434-442, http://www.annfammed.org/content/15/5/434.full.pdf+html ↩︎
  909. Andrew Loehrer et al., “Association of the Affordable Care Act Medicaid Expansion with Access to and Quality of Care for Surgical Conditions,” Journal of the American Medical Association Surgery, epub ahead of print (January 2018), https://jamanetwork.com/journals/jamasurgery/article-abstract/2670459?redirect=true ↩︎
  910. Sayeh Nikpay, Seth Freedman, Helen Levy, and Tom Buchmueller, “Effect of the Affordable Care Act Medicaid Expansion on Emergency Department Visits: Evidence From State-Level Emergency Department Databases,” Annals of Emergency Medicine 70, no.2 (August 2017), http://www.annemergmed.com/article/S0196-0644(17)30319-0/pdf ↩︎
  911. Johanna Maclean and Brendan Saloner, “The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act,” Journal of Policy Analysis and Management 38, no. 2 (2019): 366-393, https://www.ncbi.nlm.nih.gov/pubmed/30882195 ↩︎
  912. Monique Barakat et al., “Affordable Care Act and Healthcare Delivery: A Comparison of California and Florida Hospitals and Emergency Departments,” PLoS ONE 12 no. 8 (August 2017), http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0182346 ↩︎
  913. Eili Klein et al., “The Effect of Medicaid Expansion on Utilization in Maryland Emergency Departments,” Annals of Emergency Medicine epub ahead of print (June 2017), http://www.annemergmed.com/article/S0196-0644(17)30784-9/pdf ↩︎
  914. Aabha Sharma, Scott Dresden, Emilie Powell, Raymond Kang, Joe Feinglass, “Emergency Department Visits and Hospitalizations for the Uninsured in Illinois Before and After Affordable Care Act Insurance Expansion,” Journal of Community Health 42 no. 3 (June 2017): 591-597, https://link.springer.com/article/10.1007/s10900-016-0293-4 ↩︎
  915. Vivian Wu et al., “Early Impact of the Affordable Care Act Coverage Expansion on Safety-Net Hospital Inpatient Payer Mix and Market Shares,” Health Services Research (January 2018), http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12812/full ↩︎
  916. David Dranove, Craig Garthwaite, and Christopher Ody, The Impact of the ACA’s Medicaid Expansion on Hospitals’ Uncompensated Care Burden and the Potential Effects of Repeal, (The Commonwealth Fund, May 2017), http://www.commonwealthfund.org/publications/issue-briefs/2017/may/aca-medicaid-expansion-hospital-uncompensated-care ↩︎
  917. Fredric Blavin, How Has the ACA Changed Finances for Different Types of Hospitals? Updated Insights from 2015 Cost Report Data (The Urban Institute, April 2017), http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2017/rwjf436310 ↩︎
  918. Craig Garthwaite, Tal Gross, Matthew Notowidigdo, and John Graves, “Insurance Expansion and Hospital Emergency Department Access: Evidence from the Affordable Care Act,” Annals of Internal Medicine 166 no. 3 (February 2017): 172-179, http://annals.org/aim/article/2593599/insurance-expansion-hospital-emergency-department-access-evidence-from-affordable-care ↩︎
  919. Nathalie Huguet et al., “Medicaid Expansion Produces Long-Term Impact on Insurance Coverage Rates in Community Health Centers,” Journal of Primary Care & Community Health epub ahead of print (May 2017), http://journals.sagepub.com/doi/full/10.1177/2150131917709403 ↩︎
  920. Susan Camilleri, “The ACA Medicaid Expansion, Disproportionate Share Hospitals, and Uncompensated Care” Health Services Research epub ahead of print (May 2017), http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12702/abstract ↩︎
  921. Natalia Chalmers, Jane Grover, and Rob Compton, “After Medicaid Expansion in Kentucky, Use of Hospital Emergency Departments for Dental Conditions Increased,” Health Affairs 35, no. 12 (December 2016), http://content.healthaffairs.org/content/35/12/2268.full#xref-ref-32-1 ↩︎
  922. Arkansas Health Reform Legislative Task Force, Health Care Task Force Preliminary Report, (Arkansas Health Reform Legislative Task Force, December 2015), http://www.arkleg.state.ar.us/assembly/2015/Meeting%20Attachments/836/I14218/Task%20Force%20report%2012-17-15%20sent%20to%20Jill.pdf ↩︎
  923. Arkansas Hospital Association, “Survey Reveals Private Option Impact on Hospitals,” The Notebook 21, no. 33 (November 2014), http://www.arkhospitals.org/archive/notebookpdf/Notebook_11-03-14.pdf ↩︎
  924. Mary Anderson, Jeffrey Glasheen, and Debra Anoff, “Impact of State Medicaid Expansion Status on Length of Stay and In-Hospital Mortality for General Medicine Patients at US Academic Medical Centers,” Journal of Hospital Medicine Epub ahead of print (August 2016), http://onlinelibrary.wiley.com/wol1/doi/10.1002/jhm.2649/citedby ↩︎
  925. The University of Michigan Institute for Healthcare Policy & Innovation, The Healthy Michigan Plan: 2015 Report on Uncompensated Care and Insurance Rates (The University of Michigan Institute for Healthcare Policy & Innovation, prepared for the Michigan Department of Health and Human Services and the Michigan Department of Insurance and Financial Services, December 2016), http://www.michigan.gov/documents/mdhhs/2015_Report_on_Uncompensated_Care_and_Insurance_Rates-HMP_547720_7.pdf ↩︎
  926. Laurie Felland, Peter Cunningham, Annie Doubleday, and Cannon Warren, Effects of the Affordable Care Act on Safety Net Hospitals (Washington, DC: Mathematica Policy Research, prepared for the Assistant Secretary for Planning and Evaluation, November 2016), https://aspe.hhs.gov/sites/default/files/pdf/255491/SafetyNetHospital.pdf ↩︎
  927. Sayeh Nikpay, Thomas Buchmueller, and Helen Levy. “Affordable Care Act Medicaid Expansion Reduced Uninsured Hospital Stays in 2014,” Health Affairs 35, no.1 (January 2016): 106-110, http://content.healthaffairs.org/content/35/1/106.full ↩︎
  928. Fred Hellinger, “In Four ACA Expansion States, The Percentage of Uninsured Hospitalizations for People With HIV Declined, 2012-14,” Health Affairs 34, no. 12 (December 2015): 2061-2068, http://search.proquest.com/docview/1749932806/627DA95CDEA44BE7PQ/77?accountid=39486# ↩︎
  929. Deborah Bachrach, Patricia Boozang, and Mindy Lipson, The Impact of Medicaid Expansion on Uncompensated Care Costs: Early Results and Policy Implications for States, (Manatt Health Solutions, prepared by the Robert Wood Johnson Foundation’s State Health Reform Assistance Network, June 2015), https://www.manatt.com/uploadedFiles/Content/5_Insights/White_Papers/State-Network-Manatt-Impact-of-Medicaid-Expansion-on-Uncompensated-Care-Costs-June-2015.pdf ↩︎
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  935. David Dranove, Craig Garthwaite, and Christopher Ody, “Uncompensated Care Decreased At Hospitals In Medicaid Expansion States But Not At Hospitals In Nonexpansion States,” Health Affairs 35 no. 8 (August 2016): 1471-1479, http://content.healthaffairs.org/content/35/8/1471.full ↩︎
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  937. Christine Jones, Serena Scott, Debra Anoff, Read Pierce, and Jeffrey Glasheen, “Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion,” Inquiry: The Journal of Health Care Organization, Provision, and Financing 52 (August 2015), http://inq.sagepub.com/content/52/0046958015602464.full ↩︎
  938. Nadia Laniado, Avery R. Brow, Eric Tranby, and Victor M. Badner, “Trends in Non-Traumatic Dental Emergency Department Use in New York and New Jersey: A Look at Medicaid Expansion from Both Sides of the Hudson River,” Journal of Public Health Dentistry Epub ahead of print (October 2019), https://doi.org/10.1111/jphd.12343 ↩︎
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  940. Robin Rudowitz and Rachel Garfield, New Analysis Shows States with Medicaid Expansion Experienced Declines in Uninsured Hospital Discharges (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, September 2015), http://kff.org/health-reform/issue-brief/new-analysis-shows-states-with-medicaid-expansion-experienced-declines-in-uninsured-hospital-discharges/ ↩︎
  941. Jordan Rhodes, Thomas Buchmueller, Helen Levy, and Sayeh Nikpay, “Heterogeneous Effects Of The Aca Medicaid Expansion On Hospital Financial Outcomes,” Contemporary Economic Policy epub ahead of print (April 2019), https://onlinelibrary.wiley.com/doi/full/10.1111/coep.12428 ↩︎
  942. Gary Young, Stephen Flaherty, E. Zepeda, Simone Singh, and Sara Rosenbaum, “Impact of ACA Medicaid Expansion on Hospitals’ Financial Status” Journal of Healthcare Management 64, no. 2 (March 2019): 91–102, https://insights.ovid.com/crossref?an=00115514-201904000-00007 ↩︎
  943. Nathalie Huguet et al., “The Impact of the Affordable Care Act (ACA) Medicaid Expansion on Visit Rates for Diabetes in Safety Net Health Centers,” Journal of the American Board of Family Medicine 31, no. 6 (November 2018): 905-916, https://www.jabfm.org/content/31/6/905.full ↩︎
  944. Susan Dorr Goold et al., “Primary Care Clinicians’ Views About the Impact of Medicaid Expansion in Michigan: A Mixed Methods Study,” Journal of General Internal Medicine 33, no. 8 (June 2018): 1307-1316, https://link.springer.com/article/10.1007/s11606-018-4487-6 ↩︎
  945. Pennsylvania Department of Human Services, Medicaid Expansion Report, (Pennsylvania Department of Human Services, January 2017), http://www.dhs.pa.gov/cs/groups/webcontent/documents/document/c_257436.pdf ↩︎
  946. Megan Cole, Brad Wright, Ira Wilson, Omar Gallarraga, and Amal Trivedi, “Medicaid Expansion And Community Health Centers: Care Quality And Service Use Increased For Rural Patients” Health Affairs 37, no. 6 (June 2018), https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2017.1542 ↩︎
  947. Mark Duggan, Atul Gupta, and Emilie Jackson, The Impact of the Affordable Care Act: Evidence from California’s Hospital Sector (National Bureau of Economic Research, working paper no. 25488, January 2019), https://www.nber.org/papers/w25488.pdf ↩︎
  948. Sara Rosenbaum, Jennifer Tolbert, Jessica Sharac, Peter Shin, Rachel Gunsalus, and Julia Zur, Community Health Centers: Growing Importance in a Changing Health Care System (Washington, DC: Kaiser Family Foundation, March 2018), https://modern.kff.org/medicaid/issue-brief/community-health-centers-growing-importance-in-a-changing-health-care-system/ ↩︎
  949. Michel Boudreaux, Yoon Choi, Liyang Xie, and Daniel Marthey, “Medicaid Expansion at Title X Clinics: Client Volume, Payer Mix, and Contraceptive Method Type,” Medical Care epub ahead of print (April 2019), https://www.ncbi.nlm.nih.gov/pubmed/30973473 ↩︎
  950. Christina Andrews et al., “Medicaid Coverage In Substance Use Disorder Treatment After The Affordable Care Act,” Journal of Substance Abuse Treatment epub ahead of print (April 2019), https://www.sciencedirect.com/science/article/pii/S0740547218305750 ↩︎
  951. Jesse Pines, Rahul Ladhania BTech, Bernard Black , Christopher Corbit, Jestin Carlson, and Arvind Venkat, “Changes in Reimbursement to Emergency Physicians After Medicaid Expansion Under the Patient Protection and Affordable Care Act,” Annals of Emergency Medicine 73, no. 3 (March 2019): 213-224, https://www.sciencedirect.com/science/article/pii/S019606441831374X ↩︎
  952. Heather Angier et al., “Racial/Ethnic Disparities in Health Insurance and Differences in Visit Type for a Population of Patients with Diabetes after Medicaid Expansion” Journal of Health Care for the Poor and Underserved 30, no.1, (March 2019) 116–130: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429963/ ↩︎
  953. Gary Pickens et al., “Changes In Hospital Service Demand, Cost, And Patient Illness Severity Following Health Reform,” Health Services Research (May 2019), https://doi.org/10.1111/1475-6773.13165 ↩︎
  954. Neal Bhutiani, Brian Harbrecht, Charles Scoggins, and Matthew Bozeman, “Evaluating The Early Impact Of Medicaid Expansion On Trends In Diagnosis And Treatment Of Benign Gallbladder Disease In Kentucky,” The American Journal of Surgery (January 2019), https://www.americanjournalofsurgery.com/article/S0002-9610(18)30894-8/fulltext ↩︎
  955. Brendan Saloner, Sachini Bandara, Emma McGinty, and Colleen Barry, “Justice-Involved Adults With Substance Use Disorders: Coverage Increased but Rates of Treatment Did Not in 2014,” Health Affairs 35 no. 6 (June 2016), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.0005 ↩︎
  956. Brendan Saloner, Sachini Bandara, Emma McGinty, and Colleen Barry, “Justice-Involved Adults With Substance Use Disorders: Coverage Increased but Rates of Treatment Did Not in 2014,” Health Affairs 35 no. 6 (June 2016), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.0005 ↩︎
  957. Ehimare Akhabue, Lindsay Pool, Clyde Yancy, Philip Greenland, and Donald Lloyd-Jones, “Association of State Medicaid Expansion With Rate of Uninsured Hospitalizations for Major Cardiovascular Events, 2009-2014,” JAMA Network Open 1, no. 4 (August 2018), https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2698077 ↩︎
  958. Manzilat Akande Peter Minneci, Katherine Deans, Henry Xiang, and Jennifer Cooper, “Association of Medicaid Expansion Under the Affordable Care Act With Outcomes and Access to Rehabilitation in Young Adult Trauma Patients,” JAMA Surgery 153, no. 8 (August 2018), https://jamanetwork.com/journals/jamasurgery/article-abstract/2682872?widget=personalizedcontent&previousarticle=2719270 ↩︎
  959. Cheryl Zogg et al., “Impact of Affordable Care Act Insurance Expansion on Pre-Hospital Access to Care: Changes in Adult Perforated Appendix Admission Rates after Medicaid Expansion and the Dependent Coverage Provision,” Journal of the American College of Surgeons 228, no. 1 (January 2019): 29-43, https://www.journalacs.org/article/S1072-7515(18)32078-7/fulltext ↩︎
  960. Cheryl Zogg et al., “Association of Medicaid Expansion With Access to Rehabilitative Care in Adult Trauma Patients,” JAMA Surgery epub ahead of print (January 2019), https://jamanetwork.com/journals/jamasurgery/article-abstract/2719270?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamasurg.2018.5177 ↩︎
  961. Rishi Wadhera et al., “Association of State Medicaid Expansion With Quality of Care and Outcomes for Low-Income Patients Hospitalized With Acute Myocardial Infarction,” JAMA Cardiology 4, no. 2 (January 2019): 120-127, https://jamanetwork.com/journals/jamacardiology/article-abstract/2720425?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamacardio.2018.4577 ↩︎
  962. Angelica Meinhofer and Allison Witman, “The Role Of Health Insurance On Treatment For Opioid Use Disorders: Evidence From The Affordable Care Act Medicaid Expansion,” Journal of Health Economics 60 (June 2018): 177-197, https://www.sciencedirect.com/science/article/abs/pii/S0167629617311530 ↩︎
  963. Favel Mondesir et al., “Medicaid Expansion and Hospitalization for Ambulatory Care–Sensitive Conditions Among Nonelderly Adults With Diabetes,” Journal of Ambulatory Care Management epub ahead of print (May 2019), https://insights.ovid.com/pubmed?pmid=31107800 ↩︎
  964. Xinxin Han, Quian Luo, and Leighton Ku, “Medicaid Expansion and Grant Funding Increases Helped Improve Community Health Center Capacity,” Health Affairs 36 no. 1 (January 2017): 49-56, http://content.healthaffairs.org/content/36/1/49.full?sid=a3089120-6f4b-428b-bba8-5f005b444e19 ↩︎
  965. Josh Gray, Iyue Sung, and Stewart Richardson, Observations on the Affordable Care Act: 2014 (athenaResearch and Robert Wood Johnson Foundation ACA View Report, February 2015), http://www.athenahealth.com/~/media/athenaweb/files/pdf/acaview_year_end_2014.pdf ↩︎
  966. Gary Pickens et al., “Changes in Hospital Inpatient Utilization Following Health Care Reform,” Health Services Research epub ahead of print (June 2017), https://www.ncbi.nlm.nih.gov/pubmed/28664983 ↩︎
  967. Megan Hoopes, Heather Angier, Rachel Gold, Steffani Bailey, Nathalie Huguet, Miguel Marino, and Jennifer DeVoe, “Utilization of Community Health Centers in Medicaid Expansion and Nonexpansion States, 2013-2014,” Journal of Ambulatory Care Management 39 no. 4 (October 2016): 290-298, https://www.ncbi.nlm.nih.gov/pubmed/26765808 ↩︎
  968. Peter Shin, Jessica Sharac, Julia Zur, Sara Rosenbaum, and Julia Paradise, Health Center Patient Trends, Enrollment Activities, and Service Capacity: Recent Experience in Medicaid Expansion and Non-Expansion States (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, December 2015), http://kff.org/medicaid/issue-brief/health-center-patient-trends-enrollment-activities-and-service-capacity-recent-experience-in-medicaid-expansion-and-non-expansion-states/ ↩︎
  969. Steven Wallace, Maria-Elena Young, Michael Rodriguez, Amy Bonilla, and Nadereh Pourat, Community Health Centers Play a Critical Role in Caring for the Remaining Uninsured in the Affordable Care Act Era (UCLA Center for Health Policy Research, October 2016), http://healthpolicy.ucla.edu/publications/Documents/PDF/2016/FQHC_PB-oct2016.pdf ↩︎
  970. Jesse M. Pines, Mark Zocchi, Ali Moghtaderi, Bernard Black, Steven A. Farmer, Greg Hufstetler, Kevin Klauer and Randy Pilgrim, “Medicaid Expansion In 2014 Did Not Increase Emergency Department Use But Did Change Insurance Payer Mix,” Health Affairs 35, no. 8 (August 2016), http://content.healthaffairs.org/content/35/8/1480.full ↩︎
  971. Mathew Davis, Achamyeleh Gebremariam, John Ayanian, “Changes in Insurance Coverage Among Hospitalized Nonelderly Adults After Medicaid Expansion in Michigan,” The Journal of the American Medical Association 315 no. 23 (June 2016): 2617-2618, http://jamanetwork.com/journals/jama/fullarticle/2529615 ↩︎
  972. Brystana Kaufman, Kristin Reiter, George Pink, and George Holmes, “Medicaid Expansion Affects Rural and Urban Hospitals Differently,” Health Affairs 35 no. 9 (September 2016): 1665-1672, http://content.healthaffairs.org/content/35/9/1665.full?sid=4aea494e-8e02-4c66-8298-3c828bfc313b ↩︎
  973. Eric Charles et al., “Impact of Medicaid Expansion on Cardiac Surgery Volume and Outcomes,” The Annals of Thoracic Surgery (June 2017), http://www.annalsthoracicsurgery.org/article/S0003-4975(17)30552-0/pdf ↩︎
  974. Megan Cole, Omar Galarraga, Ira Wilson, Brad Wright, and Amal Trivedi, “At Federally Funded Health Centers, Medicaid Expansion was Associated with Improved Quality of Care,” Health Affairs 36 no. 1 (January 2017): 40-48, http://content.healthaffairs.org/content/36/1/40.full?sid=a3089120-6f4b-428b-bba8-5f005b444e19 ↩︎
  975. Stephen Berry et al., “Healthcare Coverage for HIV Provider Visits before and after Implementation of the Affordable Care Act,” Clinical Infectious Diseases, (May 2016), http://www.ncbi.nlm.nih.gov/pubmed/27143660 ↩︎
  976. Ramiro Manzano-Nunez et al., “Association of Medicaid Expansion Policy with Outcomes in Homeless Patients Requiring Emergency General Surgery,” World Journal of Surgery 43, no. 6 (June 2019): 1483-1489, https://link.springer.com/article/10.1007/s00268-019-04932-0 ↩︎
  977. Craig Garthwaite et al., All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act (National Bureau of Economic Research, Working Paper No. 26289, September 2019), http://www.nber.org/papers/w26289 ↩︎
  978. Alexander T. Janke, Shooshan Danagoulian, Arjun K. Venkatesh, and Phillip D. Levy, “Medicaid Expansion and Resource Utilization in the Emergency Department,” The American Journal of Emergency Medicine Epub ahead of print (January 2020), https://doi.org/10.1016/j.ajem.2019.12.050 ↩︎
  979. Hawazin W. Elani, Ichiro Kawachi, and Benjamin D. Sommers, “Changes in Emergency Department Dental Visits after Medicaid Expansion,” Health Services Research Epub ahead of print (January 2020), https://doi.org/10.1111/1475-6773.13261 ↩︎
  980. Beatrice D. Probst, Luther Walls, Michael Cirone, and Talar Markossian, “Examining the Effect of the Affordable Care Act on Two Illinois Emergency Departments,” Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health 20, no. 5 (September 2019): 710-716, https://doi.org/10.5811/westjem.2019.6.41943 ↩︎
  981. Shannon McConville, Maria Raven, Sarah Sabbagh, and Renee Hsia, “Frequent Emergency Department Users: A Statewide Comparison Before And After Affordable Care Act Implementation,” Health Affairs 37, no. 6, (June 2018), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0784 ↩︎
  982. Sayeh Nikpay, Seth Freedman, Helen Levy, and Tom Buchmueller, “Effect of the Affordable Care Act Medicaid Expansion on Emergency Department Visits: Evidence From State-Level Emergency Department Databases,” Annals of Emergency Medicine 70, no.2 (August 2017), http://www.annemergmed.com/article/S0196-0644(17)30319-0/pdf ↩︎
  983. Monique Barakat et al., “Affordable Care Act and Healthcare Delivery: A Comparison of California and Florida Hospitals and Emergency Departments,” PLoS ONE 12 no. 8 (August 2017), http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0182346 ↩︎
  984. Rahul Ladhania, Amelia Haviland, Arvind Venkat, Rahul Telang, and Jesse Pines, “The Effect of Medicaid Expansion on the Nature of New Enrollees’ Emergency Department Use,” Medical Care Research and Review epub ahead of print (May 2019), https://journals.sagepub.com/doi/abs/10.1177/1077558719848270 ↩︎
  985. Jesse M. Pines, Mark Zocchi, Ali Moghtaderi, Bernard Black, Steven A. Farmer, Greg Hufstetler, Kevin Klauer and Randy Pilgrim, “Medicaid Expansion In 2014 Did Not Increase Emergency Department Use But Did Change Insurance Payer Mix,” Health Affairs 35, no. 8 (August 2016), http://content.healthaffairs.org/content/35/8/1480.full ↩︎
  986. Craig Garthwaite, Tal Gross, Matthew Notowidigdo, and John Graves, “Insurance Expansion and Hospital Emergency Department Access: Evidence from the Affordable Care Act,” Annals of Internal Medicine 166 no. 3 (February 2017): 172-179, http://annals.org/aim/article/2593599/insurance-expansion-hospital-emergency-department-access-evidence-from-affordable-care ↩︎
  987. Eili Klein et al., “The Effect of Medicaid Expansion on Utilization in Maryland Emergency Departments,” Annals of Emergency Medicine epub ahead of print (June 2017), http://www.annemergmed.com/article/S0196-0644(17)30784-9/pdf ↩︎
  988. Aabha Sharma, Scott Dresden, Emilie Powell, Raymond Kang, Joe Feinglass, “Emergency Department Visits and Hospitalizations for the Uninsured in Illinois Before and After Affordable Care Act Insurance Expansion,” Journal of Community Health 42 no. 3 (June 2017): 591-597, https://link.springer.com/article/10.1007/s10900-016-0293-4 ↩︎
  989. Gary Pickens et al., “Changes In Hospital Service Demand, Cost, And Patient Illness Severity Following Health Reform,” Health Services Research (May 2019), https://doi.org/10.1111/1475-6773.13165 ↩︎
  990. Jesse Pines, Rahul Ladhania BTech, Bernard Black , Christopher Corbit, Jestin Carlson, and Arvind Venkat, “Changes in Reimbursement to Emergency Physicians After Medicaid Expansion Under the Patient Protection and Affordable Care Act,” Annals of Emergency Medicine 73, no. 3 (March 2019): 213-224, https://www.sciencedirect.com/science/article/pii/S019606441831374X ↩︎
  991. Johanna Maclean and Brendan Saloner, “The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act,” Journal of Policy Analysis and Management 38, no. 2 (2019): 366-393, https://www.ncbi.nlm.nih.gov/pubmed/30882195 ↩︎
  992. Christina Andrews et al., “Medicaid Coverage In Substance Use Disorder Treatment After The Affordable Care Act,” Journal of Substance Abuse Treatment epub ahead of print (April 2019), https://www.sciencedirect.com/science/article/pii/S0740547218305750 ↩︎
  993. Ramin Mojtabai, Christine Mauro, Melanie Wall, Colleen Barry, and Mark Olfson, “The Affordable Care Act and Opioid Agonist Therapy for Opioid Use Disorder,” Psychiatry Online (April 2019), https://doi.org/10.1176/appi.ps.201900025 ↩︎
  994. Angelica Meinhofer and Allison Witman, “The Role Of Health Insurance On Treatment For Opioid Use Disorders: Evidence From The Affordable Care Act Medicaid Expansion,” Journal of Health Economics 60 (June 2018): 177-197, https://www.sciencedirect.com/science/article/abs/pii/S0167629617311530 ↩︎
  995. Brendan Saloner, Sachini Bandara, Emma McGinty, and Colleen Barry, “Justice-Involved Adults With Substance Use Disorders: Coverage Increased but Rates of Treatment Did Not in 2014,” Health Affairs 35 no. 6 (June 2016), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.0005 ↩︎
  996. Mark Clapp et al., “Association of Medicaid Expansion With Coverage and Access to Care for Pregnant Women,” Obstetrics & Gynecology 134, no. 5 (November 2019): 1066-1074, https://doi.org/10.1097/aog.0000000000003501 ↩︎
  997. Rishi Wadhera et al., “Association of the Affordable Care Act’s Medicaid Expansion With Care Quality and Outcomes for Low-Income Patients Hospitalized With Heart Failure,” Circulation: Cardiovascular Quality and Outcomes 11, no. 7 (June 2018), https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.004729 ↩︎
  998. Emanuel Eguia et al., “The Impact of the Affordable Care Act Medicaid Expansion on Vascular Surgery,” Annals of Vascular Surgery Epub ahead of print (January 2020), https://doi.org/10.1016/j.avsg.2020.01.006 ↩︎
  999. Donald Likosky, Devraj Sukul, Milan Seth, Chang He, Hitlander Gurm, and Richard Prager, “The Association Between Medicaid Expansion and Cardiovascular Interventions: The Michigan Experience,” Journal of the American College of Cardiology 71, no. 9 (March 2018): 1050-1051, https://www.sciencedirect.com/science/article/pii/S0735109718300056?via%3Dihub ↩︎
  1000. Rishi Wadhera et al., “Association of State Medicaid Expansion With Quality of Care and Outcomes for Low-Income Patients Hospitalized With Acute Myocardial Infarction,” JAMA Cardiology 4, no. 2 (January 2019): 120-127, https://jamanetwork.com/journals/jamacardiology/article-abstract/2720425?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamacardio.2018.4577 ↩︎
  1001. Andrew Crocker et al., “Expansion Coverage And Preferential Utilization Of Cancer Surgery Among Racial And Ethnic Minorities And Low-Income Groups,” Surgery epub ahead of print (June 2019), https://www.surgjournal.com/article/S0039-6060(19)30198-9/fulltext ↩︎
  1002. Ehimare Akhabue, Lindsay Pool, Clyde Yancy, Philip Greenland, and Donald Lloyd-Jones, “Association of State Medicaid Expansion With Rate of Uninsured Hospitalizations for Major Cardiovascular Events, 2009-2014,” JAMA Network Open 1, no. 4 (August 2018), https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2698077 ↩︎
  1003. Favel Mondesir et al., “Medicaid Expansion and Hospitalization for Ambulatory Care–Sensitive Conditions Among Nonelderly Adults With Diabetes,” Journal of Ambulatory Care Management epub ahead of print (May 2019), https://insights.ovid.com/pubmed?pmid=31107800 ↩︎
  1004. Andrew Loehrer et al., “Association of the Affordable Care Act Medicaid Expansion with Access to and Quality of Care for Surgical Conditions,” Journal of the American Medical Association Surgery, epub ahead of print (January 2018), https://jamanetwork.com/journals/jamasurgery/article-abstract/2670459?redirect=true ↩︎
  1005. Cheryl Zogg et al., “Impact of Affordable Care Act Insurance Expansion on Pre-Hospital Access to Care: Changes in Adult Perforated Appendix Admission Rates after Medicaid Expansion and the Dependent Coverage Provision,” Journal of the American College of Surgeons 228, no. 1 (January 2019): 29-43, https://www.journalacs.org/article/S1072-7515(18)32078-7/fulltext ↩︎
  1006. Andrew Admon, Michael Sjoding, Sarah Lyon, John Ayanian, Theodore Iwashyna, and Colin Cooke, “Medicaid Expansion and Mechanical Ventilation in Asthma, Chronic Obstructive Pulmonary Disease, and Heart Failure,” Annals of the American Thoracic Society epub ahead of print (February 2019), https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201811-777OC ↩︎
  1007. John Scott et al., “Lifting the Burden: State Medicaid Expansion Reduces Financial Risk for the Injured,” Journal of Trauma and Acute Care Surgery Epub ahead of print (September 2019), https://doi.org/10.1097/ta.0000000000002493 ↩︎
  1008. Charles A. Daly et al., “The Effects of Medicaid Expansion on Triage and Regional Transfer After Upper-Extremity Trauma,” The Journal of Hand Surgery 44, no. 9 (September 2019): 720-727, https://doi.org/10.1016/j.jhsa.2019.05.020 ↩︎
  1009. Cheryl Zogg et al., “Association of Medicaid Expansion With Access to Rehabilitative Care in Adult Trauma Patients,” JAMA Surgery epub ahead of print (January 2019), https://jamanetwork.com/journals/jamasurgery/article-abstract/2719270?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamasurg.2018.5177 ↩︎
  1010. Manzilat Akande Peter Minneci, Katherine Deans, Henry Xiang, and Jennifer Cooper, “Association of Medicaid Expansion Under the Affordable Care Act With Outcomes and Access to Rehabilitation in Young Adult Trauma Patients,” JAMA Surgery 153, no. 8 (August 2018), https://jamanetwork.com/journals/jamasurgery/article-abstract/2682872?widget=personalizedcontent&previousarticle=2719270 ↩︎
  1011. Neal Bhutiani, Brian Harbrecht, Charles Scoggins, and Matthew Bozeman, “Evaluating The Early Impact Of Medicaid Expansion On Trends In Diagnosis And Treatment Of Benign Gallbladder Disease In Kentucky,” The American Journal of Surgery (January 2019), https://www.americanjournalofsurgery.com/article/S0002-9610(18)30894-8/fulltext ↩︎
  1012. Emanuel Eguia et al., “Impact of the Affordable Care Act (ACA) Medicaid Expansion on Cancer Admissions and Surgeries,” Annals of Surgery 268, no. 4 (October 2018): 584-590, https://journals.lww.com/annalsofsurgery/Abstract/2018/10000/Impact_of_the_Affordable_Care_Act__ACA__Medicaid.6.aspx ↩︎
  1013. J.W. Awori Hayanga et al., “Lung Transplantation and Affordable Care Act Medicaid Expansion in the Era of Lung Allocation Score” Transplant International epub ahead of print (February 2019), https://onlinelibrary.wiley.com/doi/pdf/10.1111/tri.13420 ↩︎
  1014. Meera Harhay et al., “Association between Medicaid Expansion under the Affordable Care Act and Preemptive Listings for Kidney Transplantation,” Clinical Journal of the American Society of Nephrology 13 (July 2018), https://cjasn.asnjournals.org/content/13/7/1069 ↩︎
  1015. Meera N. Harhay, Ryan M. McKenna, and Michael O. Harhay, “Association Between Medicaid Expansion Under the Affordable Care Act and Medicaid-Covered Pre-emptive Kidney Transplantation,” Journal of General Internal Medicine 34, no. 11 (November 2019): 2322-2325, https://doi.org/10.1007/s11606-019-05279-x ↩︎
  1016. Dmitry Tumin et al., “Medicaid Participation among Liver Transplant Candidates after the Affordable Care Act Medicaid Expansion” Journal of the American College of Surgeons 225, no. 2 (August 2017): 173-180.e2, https://www.journalacs.org/article/S1072-7515(17)30454-4/fulltext ↩︎
  1017. Dmitry Tumin, Don Hayes Jr., Kenneth Washburn, Joseph Tobias, and Sylvester Black, “Medicaid Enrollment after Liver Transplantation: Effects of Medicaid Expansion,” Liver Transplantation (May 2016), https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/lt.24480 ↩︎
  1018. Ramiro Manzano-Nunez et al., “Association of Medicaid Expansion Policy with Outcomes in Homeless Patients Requiring Emergency General Surgery,” World Journal of Surgery 43, no. 6 (June 2019): 1483-1489, https://link.springer.com/article/10.1007/s00268-019-04932-0 ↩︎
  1019. Susan Camilleri, “The ACA Medicaid Expansion, Disproportionate Share Hospitals, and Uncompensated Care” Health Services Research epub ahead of print (May 2017), http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12702/abstract ↩︎
  1020. Jordan Rhodes, Thomas Buchmueller, Helen Levy, and Sayeh Nikpay, “Heterogeneous Effects Of The Aca Medicaid Expansion On Hospital Financial Outcomes,” Contemporary Economic Policy epub ahead of print (April 2019), https://onlinelibrary.wiley.com/doi/full/10.1111/coep.12428 ↩︎
  1021. Tyler McClintock, Ye Wang, Mahek Shah, Benjamin Chung, and Steven Chang, “How Have Hospital Pricing Practices for Surgical Episodes of Care Responded to Affordable Care Act-Related Medicaid Expansion?” Urology 125 (March 2019): 79-85, https://doi.org/10.1016/j.urology.2018.10.034 ↩︎
  1022. Brystana Kaufman, Kristin Reiter, George Pink, and George Holmes, “Medicaid Expansion Affects Rural and Urban Hospitals Differently,” Health Affairs 35 no. 9 (September 2016): 1665-1672, http://content.healthaffairs.org/content/35/9/1665.full?sid=4aea494e-8e02-4c66-8298-3c828bfc313b ↩︎
  1023. Charles A. Daly et al., “The Effects of Medicaid Expansion on Triage and Regional Transfer After Upper-Extremity Trauma,” The Journal of Hand Surgery 44, no. 9 (September 2019): 720-727, https://doi.org/10.1016/j.jhsa.2019.05.020 ↩︎
  1024. Michael McCue, “The Impact of Medicaid Expansion on Medicaid Focused Insurers in California,” Inquiry: The Journal of Health Care Organization, Provision, and Financing 52 (July 2015), http://inq.sagepub.com/content/52/0046958015595960.full.pdf+html ↩︎
  1025. Steven Wallace, Maria-Elena Young, Michael Rodriguez, Amy Bonilla, and Nadereh Pourat, Community Health Centers Play a Critical Role in Caring for the Remaining Uninsured in the Affordable Care Act Era (UCLA Center for Health Policy Research, October 2016), http://healthpolicy.ucla.edu/publications/Documents/PDF/2016/FQHC_PB-oct2016.pdf ↩︎
  1026. Matt Warfield, Barbara DiPietro, and Samantha Artiga, How has the ACA Medicaid Expansion Affected Providers Serving the Homeless Population: Analysis of Coverage, Revenues, and Costs (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, March 2016), http://files.kff.org/attachment/issue-brief-how-has-the-aca-medicaid-expansion-affected-providers-serving-the-homeless-population ↩︎
  1027. Jane Wishner, Patricia Solleveld, Robin Rudowitz, Julia Paradise, and Larisa Antonisse, A Look at Rural Hospital Closures and Implications for Access to Care: Three Case Studies (Washington, DC: Kaiser Commission on Medicaid and the Uninsured and The Urban Institute, July 2016), http://kff.org/medicaid/issue-brief/a-look-at-rural-hospital-closures-and-implications-for-access-to-care/ ↩︎
  1028. Laurie Felland, Peter Cunningham, Annie Doubleday, and Cannon Warren, Effects of the Affordable Care Act on Safety Net Hospitals (Washington, DC: Mathematica Policy Research, prepared for the Assistant Secretary for Planning and Evaluation, November 2016), https://aspe.hhs.gov/sites/default/files/pdf/255491/SafetyNetHospital.pdf ↩︎
  1029. Rachel Garfield, Elizabeth Hinton, Elizabeth Cornachione, and Cornelia Hall, Medicaid Managed Care Plans and Access to Care: Results from the Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans (Washington, DC: Kaiser Family Foundation, March 2018), https://modern.kff.org/medicaid/report/medicaid-managed-care-plans-and-access-to-care-results-from-the-kaiser-family-foundation-2017-survey-of-medicaid-managed-care-plans ↩︎
  1030. Richard Lindrooth, Marcelo Perraillon, Rose Hardy, and Gregory Tung, “Understanding the Relationship Between Medicaid Expansions and Hospital Closures,” Health Affairs epub ahead of print (January 2018), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0976 ↩︎
  1031. Allen Dobson, Joan DaVanzo, Randy Haught, and Phap Hoa Luu, Comparing the Affordable Care Act’s Financial Impact on Safety-Net Hospitals in States that Expanded Medicaid and Those That Did Not (The Commonwealth Fund, November 2017), http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2017/nov/dobson_impact_medicaid_expanion_safety_net_hosps_ib.pdf ↩︎
  1032. Jordan Rhodes, Thomas Buchmueller, Helen Levy, and Sayeh Nikpay, “Heterogeneous Effects Of The Aca Medicaid Expansion On Hospital Financial Outcomes,” Contemporary Economic Policy epub ahead of print (April 2019), https://onlinelibrary.wiley.com/doi/full/10.1111/coep.12428 ↩︎
  1033. Fredric Blavin, How Has the ACA Changed Finances for Different Types of Hospitals? Updated Insights from 2015 Cost Report Data (The Urban Institute, April 2017), http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2017/rwjf436310 ↩︎
  1034. Mark Duggan, Atul Gupta, and Emilie Jackson, The Impact of the Affordable Care Act: Evidence from California’s Hospital Sector (National Bureau of Economic Research, working paper no. 25488, January 2019), https://www.nber.org/papers/w25488.pdf ↩︎
  1035. Peter Cunningham, Rachel Garfield, and Robin Rudowitz, How Are Hospitals Faring Under the Affordable Care Act? Early Experiences from Ascension Health (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, April 2015), http://kff.org/health-reform/issue-brief/how-are-hospitals-faring-under-the-affordable-care-act-early-experiences-from-ascension-health/ ↩︎
  1036. Peter Cunningham, Rachel Garfield, and Robin Rudowitz, How Are Hospitals Faring Under the Affordable Care Act? Early Experiences from Ascension Health (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, April 2015), http://kff.org/health-reform/issue-brief/how-are-hospitals-faring-under-the-affordable-care-act-early-experiences-from-ascension-health/ ↩︎
  1037. Rachel Garfield, Elizabeth Hinton, Elizabeth Cornachione, and Cornelia Hall, Medicaid Managed Care Plans and Access to Care: Results from the Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans (Washington, DC: Kaiser Family Foundation, March 2018), https://modern.kff.org/medicaid/report/medicaid-managed-care-plans-and-access-to-care-results-from-the-kaiser-family-foundation-2017-survey-of-medicaid-managed-care-plans ↩︎
  1038. Hefei Wen, Kenton J. Johnston, Lindsay Allen, and Teresa M. Waters, “Medicaid Expansion Associated With Reductions In Preventable Hospitalizations,” Health Affairs 38, no. 11 (November 2019): 1845-1849, https://doi.org/10.1377/hlthaff.2019.00483 ↩︎
  1039. Ramiro Manzano-Nunez et al., “Association of Medicaid Expansion Policy with Outcomes in Homeless Patients Requiring Emergency General Surgery,” World Journal of Surgery 43, no. 6 (June 2019): 1483-1489, https://link.springer.com/article/10.1007/s00268-019-04932-0 ↩︎
  1040. Elizabeth A. Brown et al., “The Impact of the ACA Medicaid Expansion on Access to Care and Hospitalization Charges for Lupus Patients,” Arthritis Care & Research Epub ahead of print (September 2019), https://doi.org/10.1002/acr.24080 ↩︎
  1041. Emanuel Eguia et al., “The Impact of the Affordable Care Act (ACA) Medicaid Expansion on Access to Minimally Invasive Surgical Care,” The American Journal of Surgery Epub ahead of print (July 2019), https://doi.org/10.1016/j.amjsurg.2019.07.003 ↩︎
  1042. Gary Young, Stephen Flaherty, E. Zepeda, Simone Singh, and Sara Rosenbaum, “Impact of ACA Medicaid Expansion on Hospitals’ Financial Status” Journal of Healthcare Management 64, no. 2 (March 2019): 91–102, https://insights.ovid.com/crossref?an=00115514-201904000-00007 ↩︎
  1043. James Richardson, Jared Llorens, and Roy Heidelberg, Medicaid Expansion and the Louisiana Economy (Louisiana Department of Health, March 2018), http://gov.louisiana.gov/assets/MedicaidExpansion/MedicaidExpansionStudy.pdf ↩︎
  1044. James A. Richardson, Jared J. Llorens, and Roy L. Heidelberg. Medicaid Expansion and the Louisiana Economy, 2018 and 2019 (Louisiana Department of Health, Prepared by Louisiana State University, August 2019), http://ldh.la.gov/assets/media/3and4.2019FinalReportMedicaidExpansionstudy.pdf ↩︎
  1045. Deloitte Development LLC, Commonwealth of Kentucky Medicaid Expansion Report, (Deloitte Development LLC, February 2015), http://jointhehealthjourney.com/images/uploads/channel-files/Kentucky_Medicaid_Expansion_One-Year_Study_FINAL.pdf ↩︎
  1046. The Colorado Health Foundation, Assessing the Economic and Budgetary Impact of Medicaid Expansion in Colorado, (The Colorado Health Foundation, March 2016), https://www.coloradohealth.org/sites/default/files/documents/2017-01/Medicaid_ExecutiveSummary_ONLINE.pdf ↩︎
  1047. John Ayanian, Gabriel Ehrlich, Donald Grimes, and Helen Levy, “Economic Effects of Medicaid Expansion in Michigan,” The New England Journal of Medicine epub ahead of print (January 2017), http://www.nejm.org/doi/full/10.1056/NEJMp1613981 ↩︎
  1048. Aparna Soni, Marguerite Burns, Laura Dague, and Kosali Simon, “Medicaid Expansion and State Trends in Supplemental Security Income Program Participation,” Health Affairs 36 no. 8, (August 2017): 1485-1488, http://content.healthaffairs.org/content/36/8/1485.full?sid=982b20c0-0a17-4dc4-a35a-b0302d4ec289 ↩︎
  1049. Renuka Tipirneni et al., “Association of Medicaid Expansion With Enrollee Employment and Student Status in Michigan,” JAMA Network Open 3, no. 1 (January 2020), https://doi.org/10.1001/jamanetworkopen.2019.20316 ↩︎
  1050. Thomas C. Buchmueller, Helen G. Levy, and Robert G. Valletta, Medicaid Expansion and the Unemployed (National Bureau of Economic Research, Working Paper No. 26553, December 2019), http://www.nber.org/papers/w26553 ↩︎
  1051. Jean Hall, Adele Shartzer, Noelle Kurth, and Kathleen Thomas, “Medicaid Expansion as an Employment Incentive Program for People With Disabilities,” American Journal of Public Health epub ahead of print (July 2018), https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2018.304536 ↩︎
  1052. Kevin Callison and Paul Sicilian, “Economic Freedom and the Affordable Care Act: Medicaid Expansions and Labor Mobility by Race and Ethnicity,” Public Finance Review 46, no. 2 (March 2018), https://journals.sagepub.com/doi/abs/10.1177/1091142116668254 ↩︎
  1053. Bryce Ward and Brandon Bridge, The Economic Impact of Medicaid Expansion in Montana: Updated Findings (Bureau of Business and Economic Research, January 2019), https://mthcf.org/wp-content/uploads/2019/01/Economic-Impact-of-MedEx-in-MT_1.28.19-FINAL.pdf ↩︎
  1054. The Ohio Department of Medicaid, 2018 Ohio Medicaid Group VIII Assessment: A Follow‐Up to the 2016 Ohio Medicaid Group VIII Assessment, (The Ohio Department of Medicaid, August 2018), https://medicaid.ohio.gov/Portals/0/Resources/Reports/Annual/Group-VIII-Final-Report.pdf An older version of this Ohio report (see citation below) found that as of 2016, 74.8% of expansion enrollees who were unemployed but looking for work reported that Medicaid enrollment made it easier to seek employment and 52.1% of expansion enrollees who were employed reported that Medicaid enrollment made it easier to continue working. The Ohio Department of Medicaid, Ohio Medicaid Group VIII Assessment: A Report to the Ohio General Assembly (The Ohio Department of Medicaid, January 2017), https://medicaid.ohio.gov/Portals/0/Resources/Reports/Annual/Group-VIII-Assessment.pdf ↩︎
  1055. Renuka Tipirneni et al., “Changes in Health and Ability to Work Among Medicaid Expansion Enrollees: a Mixed Methods Study” Journal of General Internal Medicine 34, no. 2 (February 2019): 272-280, https://link.springer.com/article/10.1007/s11606-018-4736-8 ↩︎
  1056. Susan Dorr Goold et al., “Primary Care Clinicians’ Views About the Impact of Medicaid Expansion in Michigan: A Mixed Methods Study,” Journal of General Internal Medicine 33, no. 8 (June 2018): 1307-1316, https://link.springer.com/article/10.1007/s11606-018-4487-6 ↩︎
  1057. Renuka Tipirneni et al., “Association of Expanded Medicaid Coverage With Health and Job-Related Outcomes Among Enrollees With Behavioral Health Disorders,” Psychiatric Services Epub ahead of print (September 2019), https://doi.org/10.1176/appi.ps.201900179 ↩︎
  1058. Heeju Sohn and Stefan Timmermans, “Social Effects of Health Care Reform: Medicaid Expansion under the Affordable Care Act and Changes in Volunteering,” Socius: Socialogical Research for a Dynamic World 3 (March 2017): 1-12, http://journals.sagepub.com/doi/full/10.1177/2378023117700903 ↩︎
  1059. Lizhong Peng, Xiaohui Guo, and Chad D. Meyerhoefer, “The Effects of Medicaid Expansion on Labor Market Outcomes: Evidence from Border Counties,” Health Economics Epub ahead of print (December 2019), https://doi.org/10.1002/hec.3976 ↩︎
  1060. Olga Scrivner et al., “Job Postings in the Substance Use Disorder Treatment Related Sector During the First Five Years of Medicaid Expansion,” PLoS One 15, no. 1 (January 2020), https://doi.org/10.1371/journal.pone.0228394 ↩︎
  1061. Lucie Schmidt, Lara Shore-Sheppard, and Tara Watson, The Impact of the ACA Medicaid Expansion on Disability Program Applications (National Bureau of Economic Research, Working Paper No. 26192, August 2019), http://www.nber.org/papers/w26192 ↩︎
  1062. Thomas C. Buchmueller, Helen G. Levy, and Robert G. Valletta, Medicaid Expansion and the Unemployed (National Bureau of Economic Research, Working Paper No. 26553, December 2019), http://www.nber.org/papers/w26553 ↩︎
  1063. Kevin Callison and Paul Sicilian, “Economic Freedom and the Affordable Care Act: Medicaid Expansions and Labor Mobility by Race and Ethnicity,” Public Finance Review 46, no. 2 (March 2018), https://journals.sagepub.com/doi/abs/10.1177/1091142116668254 ↩︎
  1064. Pauline Leung and Alexandre Mas, Employment Effects of the ACA Medicaid Expansions (Working Paper No. 22540, National Bureau of Economic Research, August 2016), http://www.nber.org/papers/w22540 ↩︎
  1065. Angshuman Gooptu, Asako Moriya, Kosali Simon, and Benjamin Sommers, “Medicaid Expansion Did Not Result in Significant Employment Changes or Job Reductions in 2014,” Health Affairs 35, no. 1 (January 2016): 111-118, 1-12, http://content.healthaffairs.org/content/35/1/111.short ↩︎
  1066. Bowen Garrett and Robert Kaestner, Recent Evidence on the ACA and Employment: Has the ACA Been a Job Killer? (Washington, DC: The Urban Institute and the Robert Wood Johnson Foundation, August 2015), http://www.urban.org/research/publication/recent-evidence-aca-and-employment-has-aca-been-job-killer/view/full_report ↩︎
  1067. Robert Kaestner, Bowen Garrett, Anuj Gangopadhyaya, and Caitlyn Fleming, Effects of ACA Medicaid Expansions on Health Insurance Coverage and Labor Supply (Working Paper No. 21836, National Bureau of Economic Research, December 2015), http://www.nber.org/papers/w21836 ↩︎
  1068. Priyanka Anand, Jody Schimmel Hyde, Maggie Colby, and Paul O’Leary, “The Impact of Affordable Care Act Medicaid Expansions on Applications to Federal Disability Programs,” Forum for Health Economics and Policy (February 2019), https://www.ncbi.nlm.nih.gov/pubmed/30796844 ↩︎
  1069. Emily Brown, Michelle Garrison, Hao Bao, Pingping Qu, Carole Jenny, and Ali Rowhani-Rahbar, “Assessment of Rates of Child Maltreatment in States With Medicaid Expansion vs States Without Medicaid Expansion,” JAMA Network Open 2, no. 6 (June 2019), https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2735758 ↩︎
  1070. Michel Boudreaux, James M. Noon, Brett Fried, and Joanne Pascale, “Medicaid Expansion and the Medicaid Undercount in the American Community Survey,” Health Services Research 54, no. 6 (December 2019): 1263-1272, https://doi.org/10.1111/1475-6773.13213 ↩︎
  1071. David Slusky and Donna Ginther, Did Medicaid Expansion Reduce Medical Divorce? (Working Paper No. 23139, National Bureau of Economic Research, February 2017), http://www.nber.org/papers/w23139?utm_campaign=ntw&utm_medium=email&utm_source=ntw ↩︎
  1072. Lucas Goodman, “The Effect of the Affordable Care Act Medicaid Expansion on Migration,” Journal of Policy Analysis 36, no. 1 (November 2016): 211-238, http://onlinelibrary.wiley.com/doi/10.1002/pam.21952/abstract ↩︎
  1073. Joshua Clinton and Michael Sances, “The Politics of Policy: The Initial Mass Political Effects of Medicaid Expansion in the States,” American Political Science Review 112, no. 1 (February 2018): 167-185, https://www.cambridge.org/core/journals/american-political-science-review/article/politics-of-policy-the-initial-mass-political-effects-of-medicaid-expansion-in-the-states/246AA0F10B44EFD62A7B27C661730823 ↩︎
  1074. Jake Haselswerdt, “Expanding Medicaid, Expanding the Electorate: The Affordable Care Act’s Short-Term Impact on Political Participation,” Journal of Health Politics, Policy, and Law 42, no. 4 (August 2017), https://read.dukeupress.edu/jhppl/article-abstract/42/4/667/130386/Expanding-Medicaid-Expanding-the-Electorate-The?redirectedFrom=fulltext ↩︎
  1075. Daniel Hopkins and Kalind Parish, “The Medicaid Expansion and Attitudes toward the Affordable Care Act: Testing for a Policy Feedback on Mass Opinion,” Public Opinion Quarterly 83, no. 1 (April 2019): 123-134, https://academic.oup.com/poq/article-abstract/83/1/123/5430239 ↩︎
  1076. Michael Sances and Joshua Clinton, New Policy, New Politics? The Effect of Medicaid Expansion on Public Support for the Affordable Care Act, (University of Memphis and Vanderbilt University, February 2017), https://csap.yale.edu/sites/default/files/files/apppw_jc2_3-8-17.pdf ↩︎
  1077. Richard Fording and Dana Patton, “Medicaid Expansion and the Political Fate of the Governors Who Support It,” Policy Studies Journal 47, no. 2 (January 2019), https://onlinelibrary.wiley.com/doi/full/10.1111/psj.12311 ↩︎
News Release

Poll: Americans Most at Risk for Coronavirus Complications Are No More Likely than Others to Report Taking Precautions or Making Preparations in Response to Pandemic

Low-Income, Hourly and Contract Workers are Most Likely to Worry About Lost Income and Putting Themselves at Risk by Going to Work

Published: Mar 17, 2020

In the midst of a sweeping national health and economic crisis sparked by the novel coronavirus pandemic, a new KFF coronavirus poll finds two thirds of the public (67%) say they are taking precautions as a result, and large shares worry about its impact on their family’s health and finances.

This includes four in 10 who changed travel plans (42%) or canceled plans to attend large gatherings (40%), and about a third who stocked up on food or supplies (35%). In addition, a quarter (26%) report staying home from work, school or other regular activities, while one in eight (12%) say they bought or wore a protective mask.

Though older people and those who live in a household where someone has a serious health condition are at greater risk of developing complications if they are infected with coronavirus, they are no more likely to report taking these steps.

KFF will continue to track the public’s views and experiences with the coronavirus as the situation evolves in the coming weeks and months.

“For many workers, the coronavirus pandemic is both a health and economic threat,” KFF President and CEO Drew Altman said. “Many workers – including health care workers – worry they’ll put themselves at risk because they can’t afford not to go to work. Low-wage, hourly and gig workers also have legitimate concerns about losing income as many businesses scale back or shut down.”

Fielded from March 11-15 as many schools closed and authorities moved to discourage or prohibit large public gatherings to slow the virus’ spread, the KFF coronavirus poll provides a snapshot of the public’s experience, knowledge and views during the rapidly unfolding crisis.

The poll finds about half of workers (53%) say they are worried they will lose income due to a workplace closure or reduced hours, and four in 10 (41%) worry that they will put themselves at risk of exposure to coronavirus because they cannot afford to stay home and miss work. Among those who say they or someone in their household works to provide health care services, 40% say they worry about putting themselves at risk.

Work-related worries significantly vary based on people’s work situations. For example, nearly three quarters (73%) of workers in households with annual incomes under $40,000, two-thirds of part-time workers (68%), and six in 10 of those who are paid hourly (60%) or by the job (61%) worry about lost income.

The pattern is similar for worries about risking infection because they can’t afford to miss work. Workers in low-income households and those who work part-time and are paid hourly or by the job are more likely than others to report being worried about putting themselves at risk.

The House on Saturday passed legislation endorsed by President Trump that would expand paid sick leave and family leave for workers affected by the ongoing crisis.

The poll finds about a third (32%) of workers report that they do not get paid sick leave from their employers, and half (51%) do not get paid time off for family or medical leave. Those who work part-time, workers who are paid hourly or by the job, and those with lower incomes are much less likely to report having paid leave of any type.

Overall 10% of workers say they already have lost income from a job or business because of the crisis. This includes roughly at least one in five who are self-employed (23%) or get paid by the job (21%).

About six in 10 (62%) of the public overall worry that they or a family member will get sick from the coronavirus. Parents (68%) and those with low household incomes (68%) are among the groups most likely to worry about a family member getting sick.

Amid a steep drop in the stock market in recent weeks, about half (51%) of the public also says they worry about the crisis’ impact on their retirement and college savings. More than a third (36%), including two-thirds (66%) of adults under age 65 without health insurance, worry about being able to afford tests and treatment for coronavirus if they need it.

Overall, about a third of adults (32%) say that worry and stress related to coronavirus has had a negative impact on their mental health, including 14% who say it has had a “major” impact.

Democrats and Republicans are Reacting to the Crisis Differently

Across many questions, the poll finds significant partisan differences, with Democrats generally more worried about the health and economic consequences and more likely to take specific actions in response.

For example, nearly three-quarters of Democrats (73%) but only half of Republican (50%) worry that they or a family member will get sick.  Democrats also are twice as likely as Republicans (54% vs. 27%) to worry about losing income due to workplace closures or reduced hours.

Similarly, Democrats are much more likely than Republicans to say they changed travel plans (53% vs. 29%) or cancelled plans to attend large gatherings (49% vs. 28%).

Public Mostly Knows Key Facts About Coronavirus, But Some Misconceptions Remain

The poll finds overwhelming majorities know that frequent handwashing, staying home if you are sick, and avoiding large gatherings are recommended by public health experts as a way to help slow the spread of coronavirus. The vast majority also know that adults ages 60 or older and those with pre-existing medical conditions are at a higher risk of developing serious complications.

While most adults (73%) know that someone who thinks they are experiencing symptoms of coronavirus should stay home and call a doctor or medical provider, one in four (25%) think that someone experiencing symptoms should seek immediate care at an emergency room or urgent care facility.

Other findings include:

  • Four in 10 Americans (40%) say their lives have already been disrupted a lot or some by the outbreak, though the disruptions appear to be growing. Half of those surveyed Friday through Sunday say their lives have been disrupted. Two thirds of parents (66%) dealing with school or day care closures say their lives have been disrupted, including about a third (36%) who say their lives have been disrupted “a lot.”
  • Some Americans are struggling to get needed supplies, including four in 10 (42%) who say they were unable to get cleaning supplies or hand sanitizer. One in five (19%) say they were unable to get groceries (rising to 30% among those who took the survey between March 13-15). A small share (4%) were unable to get prescription medications.
  • Despite widespread reports of the limited availability of coronavirus testing, two thirds of the public (66%) believe they would be able to get a test if they needed one. Republicans (73%) and independents (67%) are more confident than Democrats (54%) about the availability of a test.
  • The Centers for Disease Control and Prevention remains the most trusted source for reliable information about coronavirus, with 85% of the public trusting them at least a fair amount. Large majorities also trust local government (70%) and state government (71%) officials, while fewer trust the news media (47%) or President Trump (46%).

Designed and analyzed by public opinion researchers at KFF, the poll was conducted March 11-15, 2020 among a nationally representative random digit dial telephone sample of 1,216. Interviews were conducted in English and Spanish by landline (246) and cell phone (970). The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on subgroups, the margin of sampling error may be higher.

How Can Medicaid Enhance State Capacity to Respond to COVID-19?

Authors: Samantha Artiga, Robin Rudowitz, and MaryBeth Musumeci
Published: Mar 17, 2020

Issue Brief

As a source of coverage for 1 in 5 Americans, Medicaid can play a key role in connecting individuals to testing and treatment for COVID-19. Through Medicaid, states can provide enrollees access to comprehensive benefits with limited out-of-pocket cost and receive federal funding with no pre-set limit to support coverage. States have options available under existing rules to expand access to coverage and facilitate enrollment in coverage for eligible individuals. Further, states can seek federal approval for additional flexibility to expedite access to coverage and care, as has occurred in response to previous disasters and emergencies. Moreover, the federal government could take a range of administrative and legislative actions to enhance state capacity to connect individuals to care through Medicaid.

This brief describes a range of steps states and the federal government could take to use Medicaid to expand coverage and access to care in the context of responding to COVID-19 as a public health crisis. The Appendix lists specific examples of Medicaid authorities available to states in emergencies. The strategies included here are not an exhaustive list of options, and, as with any such efforts, they could involve tradeoffs and may run counter to efforts by the Trump administration and some states to restrict eligibility, limit government spending, promote program integrity, and curb immigrant use of public programs. The Medicaid and CHIP Disaster Preparedness Toolkit for state agencies also specifies strategies states can implement to respond to emergencies and disasters. Moreover, on March 12, 2020, the Centers for Medicare and Medicaid Services (CMS) posted Frequently Asked Questions (FAQs) to aid state Medicaid and Children’s Health Insurance Program agencies in their response to the COVID-19 outbreak.

Medicaid’s existing coverage and financing structure enables states to provide access to comprehensive care.

Broad source of coverage for the low-income population. As the nation’s public health insurance program for people with low income, Medicaid can be a primary vehicle through which states can connect individuals to testing and treatment for COVID-19, particularly those with significant health needs who are at high risk for experiencing complications from the virus. While most adults on Medicaid are working, the vast majority of enrollees lack access to other affordable health insurance. Medicaid plays a particularly significant role for populations with complex health needs, covering 47% of children with special health care needs, 45% of nonelderly adults with disabilities, and more than six in ten nursing home residents. Unlike other types of insurance, there are no set open enrollment periods for Medicaid, meaning that people can enroll at any time they become eligible, for example, if they experience a decrease in income due to a decline in the economy. Moreover, under law, the program provides retroactive coverage for covered services incurred up to three months prior to an enrollee’s application date if the individual would have been eligible at the time they received the service.

Comprehensive benefits. Through Medicaid, states can provide enrollees access to a broad array of services to address testing and treatment needs. States determine their Medicaid benefit package within a set of federal minimum standards and state options. All states offer at least some optional benefits, including prescription drugs. States can choose to add optional services to expand the scope of covered services to address emerging health needs. For example, in recent years, states have added an array of behavioral health and substance use disorder treatment services to address the opioid crisis. In its FAQs, CMS notes that states could expand coverage for telehealth and other services to provide care for individuals who are quarantined or self-isolated. For children, the federal minimum Medicaid benefit package offers access to all necessary services (regardless of whether these services are optional for adults) through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, which includes regular screenings, vision, dental, and hearing services and any other medically necessary care. For adults, minimum benefits include physician, inpatient and outpatient hospital, as well as laboratory services. In its FAQs, CMS clarifies that testing for COVID-19 is covered as mandatory laboratory service as long as it is provided in an office or similar facility other than a hospital outpatient department or clinic and furnished by a lab meeting specified standards. It further notes that tests that do not meet these criteria may still be covered under the optional diagnostic benefit.

No or limited out-of-pocket costs. Medicaid provides enrollees access to services with no or limited out of pocket costs. Federal rules do not require states to charge any premiums or cost sharing for Medicaid, and limit the amounts that state can charge given enrollees’ limited ability to pay out of pocket costs. As of January 2019, only two states charged copayments for children in Medicaid, but most states charged cost sharing for parents and other adults. Some states have indicated that they are waiving cost sharing associated with COVID-19 testing and/or treatment.1  States could also broadly eliminate cost sharing for categories of services or eligibility groups. In public statements, federal officials have indicated insurance companies who provide coverage through Medicaid have agreed to cover all COVID-19 testing without cost sharing and to ensure treatment is full covered. However, to date, there is no official guidance on how these policies will be implemented or documenting insurers’ agreement to this statement.

Financing structure. Medicaid provides states a guarantee of federal matching payments for covered benefits provided to enrollees with no pre-set limit. The statute sets a formula to determine the share paid by the federal government (that varies based on states’ relative per capita income). Special enhanced match rates also are provided for the ACA Medicaid expansion, administration, and other services. This matching structure provides states with resources that automatically adjust for demographic and economic shifts, health care costs, public health emergencies, natural disasters and changing state priorities. As such, federal resources will automatically increase if demands for the program grow in response to COVID-19, for example, if enrollment increases due to income decreases amid an economic decline and/or if additional eligible individuals enroll in the program to access services. Medicaid also provides “disproportionate share hospital” (DSH) payments to hospitals serving many Medicaid and uninsured patients.

States can expand Medicaid eligibility to broaden access to care.

Medicaid expansion. To date, 37 states, including DC, have adopted the ACA Medicaid expansion to adults with incomes up to 138% FPL. In the remaining 14 non-expansion states, eligibility levels for parents remain very low, often below half of poverty, and, with the exception of Wisconsin, other adults are not eligible regardless of their incomes. In these non-expansion states, 2.3 million poor uninsured adults fall into a “coverage gap”, with incomes above Medicaid eligibility limits but below the 100% FPL level at which Marketplace premium tax credits become available. Non-expansion states could significantly expand access to care for low-income adults by implementing the expansion and would receive enhanced federal matching dollars (currently at 90%) for this coverage. A substantial body of research shows that the ACA Medicaid expansion has expanded coverage, increased access to care and utilization, and improved various economic measures.

Optional eligibility expansions. Beyond the ACA Medicaid expansion to low-income adults, states have options available under federal rules to increase Medicaid eligibility above the federal minimum income limit of 138% FPL, at regular state match. For example, nearly all states (49) cover children with incomes up to at least 200% FPL through Medicaid and CHIP as of January 2019, including 19 states that cover children at or above 300% FPL. Similarly, the majority of states (47) extend eligibility to pregnant women beyond the federal minimum, including nearly half (22) who extend eligibility to above 200% FPL.

Optional coverage for legal immigrant children and pregnant women. Lawfully residing immigrants may qualify for Medicaid and CHIP but are subject to eligibility restrictions that require many to wait five years before they can enroll. States have an option to eliminate the five-year wait for lawfully residing immigrant children and pregnant women. Over half of states had adopted this option for children or pregnant women in Medicaid and/or CHIP. States also have the option to provide prenatal care to women regardless of immigration status by extending CHIP coverage to the unborn child, which 16 states had taken up as of January 2019.

Waivers of eligibility provisions. Currently, a number of states have received approval for and implemented waivers that allow them to operate their programs in way federal rules do not otherwise allow, for example, by charging premiums, imposing coverage lockouts periods, and/or not providing retroactive coverage. Given that such policies may restrict enrollment and access to care, states could suspend these waivers to facilitate access to services to address increased needs arising from COVID-19.

States can conduct outreach and adopt policy options to help get and keep eligible people enrolled in coverage.

Outreach and enrollment assistance. Nationwide, nearly a quarter (24%) of the 27.9 million nonelderly individuals who were uninsured as of 2018 were eligible for Medicaid or CHIP coverage but not enrolled. Previous state experience has illustrated that states can promote enrollment of eligible individuals through a combination of broad mass media outreach campaigns to raise awareness of coverage options as well as targeted local efforts, often in collaboration with community based organizations and/or safety-net providers, to provide direct enrollment assistance.

Presumptive eligibility and eligibility verification. Presumptive eligibility allows states to expedite connections to coverage by authorizing certain qualified entities, like community health centers or schools, to enroll individuals who appear likely eligible for coverage while the state processes the full application. Prior to the ACA, states could utilize this option for children and pregnant women. The ACA allowed states to adopt this option for other eligibility groups. The ACA also required states to allow hospitals to conduct presumptive eligibility determinations regardless of whether the state had otherwise adopted the policy. While most states have adopted this option for pregnant women and children, only a few currently utilize it for parents and other adults. In addition, under existing rules, states can allow for self-attestation for all eligibility criteria, excluding citizenship and immigration status, including on a case-by-case for individuals subject to a disaster when documentation is not available.

12-month continuous eligibility for children. States who elect to use this option can allow a child to remain enrolled for a full year unless the child ages out of coverage, moves out of state, voluntarily withdraws, or does not make premium payments. As such, 12-month continuous eligibility eliminates coverage gaps due to fluctuations in income over the course of the year, promoting stable and continuous access to care. As of January 2019, 32 states provide 12-month continuous eligibility to children in either Medicaid or CHIP. States do not have an option under federal rules to extend 12-month continuous eligibility to groups other than children, but two states (New York and Montana) have obtained waivers to provide 12-month continuous eligibility to adults.

Suspend or delay renewals. Under federal rules, states renew coverage every twelve months. States have existing authority to extend redetermination timelines for current enrollees subject to a disaster to maintain continuity of coverage. Some states have previously delayed or suspended renewals through 1115 waivers in response to emergencies. Moreover, CMS allowed states to delay or suspend renewals as a mitigation strategy when states were implementing the ACA and addressing system challenges and processing a large number of new enrollments under the Medicaid expansion.

Suspend periodic data checks between renewals. Between annual renewal periods, enrollees are required to report changes in circumstances that may affect eligibility, and states may conduct periodic electronic data matches to identify potential changes in circumstances. If a state identifies a change that may affect eligibility, it may request information or documentation from the individual to continue coverage. If the individual does not respond to a request within the required timeframe, the state will disenroll the individual from coverage. Recent reports suggest that these periodic data checks may be leading to coverage losses among eligible individuals because they do not receive or are not able to respond to information requests within required timeframes, which are limited to 10 days in many states conducting these checks. As such, suspending these data checks could help keep enrollees connected to coverage.

States can seek federal approval for additional flexibility to connect people to coverage and care.

Section 1135 waivers. If the President has declared an emergency or disaster and the Secretary of Health and Human Services (HHS) has declared a public health emergency, the Secretary can use Section 1135 authority to waive or modify certain Medicare, Medicaid, and CHIP requirements to ensure that sufficient health care items and services are available to meet the needs of Medicaid enrollees in affected areas. Examples of items that can be waived through Section 1135 authority include: conditions of participation or other certification requirements for providers; program participation and preapproval requirements for providers; requirements that physicians and other health care professionals be licensed in the state in which they are providing services (as long as they have equivalent licensing in another state for Medicare, Medicaid, and CHIP reimbursement only); and the Emergency Medical Treatment and Labor Act. The Secretary used Section 1135 to provide hurricane relief to a number of areas affected by storms during 2017. On March 13, President Trump issued a proclamation that the COVID-19 outbreak in the United States constitutes a national emergency, beginning March 1, 2020.  With this declaration, the administration announced steps to take to address COVID-19 through 1135 waivers.

Section 1115 waivers. Section 1115 waiver authority allows the Secretary of HHS to test new approaches in Medicaid not otherwise allowed under current law, provided the demonstrations meet the objectives of the program. During past emergencies, states obtained Section 1115 waivers to expedite access to coverage and health care services for affected individuals. These included waivers to: expand coverage to individuals not otherwise eligible (including adults who were not eligible for Medicaid prior the ACA), streamline application and eligibility verification processes, temporarily suspend or delay renewals for existing enrollees, waive cost sharing and/or expand benefits for targeted population groups, and address needs for individuals within specific geographic areas of a state. For example:

  • Approximately 350,000 New Yorkers were covered by Disaster Relief Medicaid in a four-month time period following the September 11th attacks in 2001. DRM allowed for a simplified expedited application process, expanded income eligibility guidelines and adjusted immigrant eligibility rules to make more New Yorkers eligible for coverage in the immediate aftermath of the disaster. It also temporarily suspended annual renewals for many existing enrollees.
  • Following Hurricane Katrina, the Department of HHS released a waiver initiative to assist states in providing temporary coverage to certain groups of evacuees. Under these waivers, states could get expedited approval to provide up to five months of Medicaid or CHIP coverage to certain evacuees and receive authorization for an “uncompensated care pool” to reimburse providers for the costs of furnishing services to uninsured evacuees and services not otherwise covered under Medicaid or CHIP (including mental health counseling). Similar to Disaster Relief Medicaid in New York, these waivers also streamlined eligibility verification criteria for the temporary coverage period.
  • In 2016, Michigan received a waiver to expand Medicaid and CHIP eligibility for children and pregnant women affected by the Flint water crises and to waive cost sharing and premiums and expand targeted case management benefits and community support services for these enrollees.
  • Following Hurricane Harvey in 2017, Texas received approval to allow individuals in the affected service area to receive services beyond their renewal period, suspended certain eligibility verification requirements, and eliminated cost sharing for the waiver period.

The federal government could take action to enhance state capacity to provide access to care through Medicaid.

Administrative Options

Provide guidance and/or a template to facilitate state adoption of policy options. CMS posted a national fact sheet outlining coverage and benefits related to COVID-19 and posted the FAQs to aid states in determining steps they can take to enhance their response. CMS also could issue guidance and/or state plan amendment and waiver templates to facilitate states’ implementation of options to enhance access to coverage and care. For example, in 2016, CMS put out an informational bulletin with information related to optional Medicaid benefits states could adopt to help address the Zika virus. In addition, CMS recently issued a waiver template to encourage states to take up options tied to the new Healthy Adult Opportunity demonstrations.

Suspend pending regulations that would limit financing. CMS is currently reviewing comments related to the Medicaid Fiscal Accountability Rule. The rule would make changes to what funding states can use for the state share of Medicaid funding and to supplemental payments to providers. The changes could have significant implications for providers and state budgets. While the rule could reduce federal spending on Medicaid, it also creates significant uncertainty for states as they work to address COVID-19.

Suspend administrative actions focused on increasing eligibility verification requirements. As part of program integrity efforts, the Trump Administration has recently increased its focus on oversight of eligibility determinations. It has indicated plans to conduct new audits of state beneficiary eligibility determinations, promoted the use of periodic data matches between renewals, and indicated plans to issue regulatory changes to increase requirements around verification, monitoring of changes in beneficiary circumstances, and eligibility redeterminations. While current and planned administrative efforts might limit instances of ineligible people being enrolled in the program, they could also result in greater enrollment barriers and coverage losses for people who are eligible and add additional administrative burden for state agencies at a time when expediting enrollment in coverage for eligible individuals would help connect them to testing and treatment.

Suspend immigration policies that may be deterring immigrant families from enrolling in coverage and seeking care. Over the past several years, the Trump Administration has implemented a range of immigration policies focusing on restricting immigration, enhancing immigration enforcement, and restricting access to public programs, including Medicaid, for immigrant families. These include recent changes to public charge policies that newly take into account use of Medicaid by non-pregnant adults as part of the public charge test federal officials use to determine whether to grant certain individuals entry into the U.S. or adjustment to legal permanent resident (LPR) status (i.e., receive a green card). A growing set of evidence suggests that families have increased fears of enrolling themselves and their children, who are primarily U.S. citizens, in Medicaid and CHIP due to these policy changes and that some may be avoiding seeking care. The administration could take steps to alleviate these fears by suspending the changes to public charge policies. They also could take steps to assure families that they will not use any information shared to enroll in coverage for immigration enforcement purposes and that enrolling in coverage and/or seeking care will not have negative effects on their immigration status. U.S. Citizenship and Immigration Services issued an alert in March 2019, encouraging all individuals with symptoms that resemble COVID-19 to seek necessary medical treatment or preventive services and noted that such treatment or services will not negatively affect future public charge tests.2 

Legislative Options

Enhance federal financing. During economic downturns, more people qualify and enroll in Medicaid, increasing program spending at the same time that state tax revenues may be stagnating or falling. To mitigate these budget pressures, Congress has twice passed temporary increases in the federal match rate to help support states during economic downturns, most recently in 2009 as part of the American Recovery and Reinvestment Act (ARRA). To receive ARRA funds, states could not roll back Medicaid eligibility. These temporary increases in the Medicaid match rate provided states fiscal capacity to address health issues for vulnerable populations through an existing, efficient mechanism. Congress could use such a mechanism to provide additional fiscal capacity for states. In addition, as providers will likely serve individuals who are uninsured or underinsured, Congress could increase funding for Medicaid disproportionate share hospital (DSH) to help reimburse hospitals for increased uncompensated care costs.

Increase access to coverage for lawfully present immigrants. As noted, lawfully residing immigrants may qualify for Medicaid and CHIP but are subject to eligibility restrictions that subject many to a five-year waiting period before they may enroll in coverage. These eligibility restrictions have been in place since 1996 under the Personal Responsibility and Work Opportunity Act. The CHIP Reauthorization Act of 2009 provided states the option to cover lawfully residing immigrant pregnant women and children without a five-year waiting period, but not other groups. Congress could enact legislation to extend this option to parents and other adults.

Families First Coronavirus Response Act. Legislation enacted on March 19, 2020 will provide coverage for COVID-19 testing with no cost sharing under Medicaid and CHIP (as well as other insurers) and provide 100% federal funding through Medicaid for testing provided to uninsured individuals for the duration of the emergency period associated with COVID-19. The law will also provide states and territories a temporary 6.2 percentage point increase in the federal matching rate for the emergency period. To receive this increase, states will need to meet certain requirements including: not implementing more restrictive eligibility standards or higher premiums than those in place as of January 1, 2020; providing continuous eligibility for enrollees through the end of the month of the emergency period unless an individual asks to be disenrolled or ceases to be a state resident; and not charging any cost sharing for any testing services or treatments for COVID-19, including vaccines, specialized equipment or therapies. The law will also increase federal allotments to the territories.

Appendix

Table 1: Medicaid Authorities Available in Emergencies
Allowed by Existing Regulations
  • Allow self-attestation to verify eligibility for all criteria except citizenship and immigration status on a case-by-case basis; verify assets if financial institution unable to verify due to disaster; verify incurred medical expenses for spend down eligibility
  • Extend renewal timeframes
  • Exempt enrollees from premiums
  • Temporarily suspend periodic data checks on case-by-case basis
  • Temporarily delay acting on certain changes in circumstances affecting eligibility
  • Reinstate services or eligibility if discontinued because whereabouts unknown due to evacuation, after whereabouts become known and if still eligible
  • Consider people evacuated from state as temporarily absent to maintain enrollment
  • Treat Federally facilitated Marketplace assessments as eligibility determinations or fully delegate eligibility determination authority to Federally facilitated Marketplace
  • Expand application processing times
  • Suspend adverse actions for those in disaster area where state has completed determination but has not yet sent notice or state believes notice likely not received
  • Temporarily increase HCBS waiver service payment rates if no change to rate methodology and no impact on cost neutrality
Amended/Updated Verification Plan – No CMS Approval Required
  • Accept self-attestation and conduct post-enrollment verification for eligibility criteria other than citizenship and immigration status (beyond case-by-case basis)
  • Adopt or increase reasonable compatibility thresholds for income inconsistencies
  • Allow reasonable explanation of inconsistencies in lieu of paper documentation
  • Temporarily suspend periodic data checks (beyond case-by-case basis)
State Plan Amendment – Can be Retroactive to 1st Day of Quarter
Coverage:
  • Increase financial eligibility thresholds (e.g., adopt ACA expansion, cover nonelderly MAGI group above 138% FPL)
  • Cover non-residents or state-defined subset of non-residents such as those living temporarily in state due to disaster in home state
  • Apply host state’s asset limit, or if less restrictive, asset limit from state where individual evacuated (if statewide rule)
Enrollment & Renewal:
  • Adopt or extend presumptive eligibility for certain populations
  • Extend hospital presumptive eligibility to non-MAGI groups
  • Establish state as presumptive eligibility qualified entity to enroll individuals based on preliminary application information
  • Provide 12-month continuous eligibility for children
  • Develop simplified paper application for affected areas
  • Extend reasonable opportunity period to provide documentation for immigration status
Benefits:
  • Temporarily modify copayment requirements to support access to services (if rule applies statewide)
  • Offer additional benefits (if comparable for all categorically needy groups and statewide with free choice of provider, or via alternative benefit plan with free choice of provider)
  • Change amount, duration, or scope of covered benefits
  • Amend payment methodology to account for increased cost of personal protective equipment for home care workers
Health Plan Contract/Oversight
  • Temporarily suspend out of network requirements for managed care enrollees
  • Require health plans to expedite processing of new prior authorization requests and allow flexibility in documentation (e.g., physician signature)
Section 1115 Waiver – state is deemed to meet budget neutrality if federally declared disaster, waiver can be retroactive to date of Secretary-declared public health emergency, exemptions from public notice in emergencies
Coverage:
  • Increase eligibility limits for specific categories in specific geographic regions

Enrollment & Renewal:

  • Provide 12-month continuous eligibility for adults or for a subset of children
  • Allow self-attestation for citizenship and immigration status if unable to verify by data sources and individual unable to document due to disaster

Benefits:

  • Provide benefits to targeted group of enrollees impacted by disaster
  • Temporarily modify copayment requirements to support access to services (less than statewide)
  • Authorize off-island coverage for those in territories eligible for FEMA transitional shelter assistance who are temporarily relocated to a state

Long-Term Services and Supports:

  • Temporarily suspend requirement to be institutionalized at least 30 days and have income below 300% SSI to be eligible for special income group
  • Temporarily suspend asset transfer rules for those placed in nursing homes
  • Apply host state’s asset limit, or if less restrictive, asset limit from state where individual evacuated (if less than statewide)
  • Do not reduce institutional provider payments by post-eligibility treatment of income
Section 1135 Waiver – if President declares national emergency and HHS Secretary declares public health emergency
Benefits:
  • Temporarily suspend fee-for-service prior authorization requirements and/or require providers to extend prior authorization through the termination of emergency declaration
Covered Providers:
  • Temporarily waive requirements for out-of-state providers to be licensed in state where they are providing services if provider is licensed by another state Medicaid agency or Medicare
  • Temporarily waive provider screening requirements, such as application fees, criminal background checks, and site visits, to ensure sufficient number of providers
  • Temporarily cease revalidation of providers in state or who are otherwise directly impacted by disaster
  • Temporarily suspend pending enforcement or termination actions or payment denial sanction to specific provider
  • Allow facilities to provide services in alternative settings such as temporary shelters when provider facility is inaccessible
  • Temporarily allow non-emergency ambulance providers

Long-Term Services and Supports:

  • Provide nursing home care to evacuees in host state for less than 30 days if individual is Medicaid-eligible in home state
  • Temporarily suspend pre-admission screening and annual resident review assessments for 30 days
  • Extend minimum data set authorizations for nursing home and skilled nursing facility residents
  • Temporarily suspend requirement that home health agency aides be supervised for 2 weeks by registered nurse
  • Temporarily suspend requirement that hospice aides be supervised by registered nurse every 14 days
  • Modify or suspend certain state survey agency activities

Appeals:

  • Allow direct access to fair hearing without first exhausting managed care appeal
  • Extend timeframes for individuals to request managed care appeals or state fair hearings
Section 1915 (c) Home and Community-based Services Waiver Appendix K – can be submitted before or during emergency, can be retroactive to date of event
Eligibility:
  •  Increase number of unduplicated waiver enrollees
  • Temporarily increase individual cost limit to assure health and welfare
  • Modify eligibility targeting criteria to serve more enrollees and forestall institutionalization in emergency
  • Extend level of care authorizations for 12 months

Benefits:

  • Add covered services not expressly authorized in statute if necessary to assist waiver enrollees to avoid institutionalization
  • Modify scope of covered services and temporarily exceed individual service limits to ensure health and welfare
  • Institute or expand self-direction
  • Temporarily suspend prior authorization and extend medical necessity authorizations
  • Modify person-centered planning process, including qualifications of individuals required to develop plan

Providers:

  • Temporarily increase payment rates with a temporary change in rate methodology and/or impact on cost neutrality
  • Amend payment methodology to account for increased cost of personal protective equipment for home care workers
  • Allow payment for services provided by family caregivers or legally responsible relatives
  • Temporarily modify provider types, qualifications, and licensure or other setting requirements
  • Include retainer payments to personal care assistants when waiver enrollee is hospitalized or absent from home up to 30 days
  • Expand covered settings to include out-of-state
  • Temporarily allow payment for waiver services up to 30 days to support enrollees in acute care hospital or short-term institutional stay when services are required for communication and behavioral stabilization and not provided by institution
SOURCES: CMS, COVID-19 Frequently Asked Questions for State Medicaid and Children’s Health Insurance Program (CHIP) Agencies (March 12, 2020); Medicaid and CHIP Coverage Learning Collaborative, Disaster Preparedness Toolkit for State Medicaid Agencies (Aug. 20, 2018); Medicaid and CHIP Coverage Learning Collaborative, Inventory of Medicaid and CHIP Flexibilities and Authorities in the Event of a Disaster (Aug. 20, 2018); CMS, 1915 (c) Home and Community-Based Services Waiver Instructions and Technical GuidanceAPPENDIX K: Emergency Preparedness and Response.

Endnotes

  1. See for example: “Governor Murphy Announces Efforts to Support Consumer Access to COVID-19 Screening, Testing, and Testing-Related Services”, State of New Jersey, accessed March 12, 2020, https://www.nj.gov/governor/news/news/562020/20200310a.shtml; “Governor Cuomo Announces New Directive Requiring New York Insurers to Waive Cost-Sharing for Coronavirus Testing”, New York State, accessed March 12, 2020, https://www.governor.ny.gov/news/governor-cuomo-announces-new-directive-requiring-new-york-insurers-waive-cost-sharing; “Gov. Whitmer announces Michigan medicaid will waive co-pays for COVID-19 testing”, WZZM13, accessed March 12, 2020, https://www.wzzm13.com/article/news/health/coronavirus/governor-whitmer-announces-copay-price-waive-for-coronavirus-testing-in-michigan/69-9e7e7363-08a3-4d4d-98db-0687e442e8f7. ↩︎
  2. U.S. Citizenship and Immigration Services, “Public Charge,” https://www.uscis.gov/greencard/public-charge, accessed March 16, 2020. ↩︎
Poll Finding

KFF Coronavirus Poll: March 2020

Published: Mar 17, 2020

Findings

In the midst of the largest health crisis to hit the United States and the world in the current era, a new KFF poll finds that many U.S. residents have faced disruptions in their lives from the coronavirus pandemic, and large shares are worried about their own risk as well as the economic consequences. This is an incredibly fast-moving crisis, with guidance and policy decisions changing daily. The new survey finds major differences from the KFF February Health Tracking Poll, and even in the span of the 5-day period in which the new survey was fielded, there were changes in the public’s levels of concern and reported behaviors. KFF will continue tracking the public’s attitudes and experiences in the coming weeks and months as the crisis evolves.

Key findings:

  • Four in ten say their life has been disrupted “a lot” or “some” as a result of the coronavirus outbreak, and many worry that they or someone in their family will get sick (62%), that their retirement or college savings will be negatively impacted (51%), or that they won’t be able to afford testing or treatment for coronavirus if they need it (36%).
  • Among workers, about half (53%) are worried they will lose income due to a workplace closure or reduced hours, and four in ten (41%) worry they will put themselves at risk of coronavirus exposure because they can’t afford to stay home from work. These worries are particularly prevalent among workers in lower-income households (earning less than $40,000 a year), part-time workers, and hourly wage-earners, many of whom say their employer does not offer them paid sick leave or paid time off to care for a sick family member.
  • Parents of children under age 18 are disproportionately worried about someone in their family getting sick, and disproportionately likely to say their lives have been disrupted by the outbreak. Among parents facing school or daycare closures, two-thirds (66%) say their life has been disrupted. Lower-income parents and those who work non-salaried jobs are the most likely to say it would be difficult to find alternative childcare in the event of a school closure.
  • The survey was in the field as social distancing measures were being put in place across the country, and many adults report taking measures like changing or canceling travel (42%), canceling plans to attend large gatherings (40%), stocking up on food, supplies and medications (35%), staying home instead of going to work or other regular activities (26%), and buying or wearing a protective mask (12%). Although older adults and those with serious health conditions are at greater risk from serious complications if infected with coronavirus, these groups are not more likely than the general public to report taking these types of precautions.
  • Large shares of the public are aware of basic facts about the symptoms of coronavirus infection, as well as methods of transmission and recommended ways to slow the spread of the disease. While most also recognize that someone who thinks they are experiencing symptoms of coronavirus infection should stay and home and call a medical provider, one-quarter think they should seek care immediately at an emergency room or urgent care facility, rising to about four in ten (38%) among those with lower incomes.
  • Large shares trust the U.S. Centers for Disease Control and Prevention and the World Health Organization to provide reliable information about coronavirus. About half (46%) trust President Trump, with sharp divides along partisan lines. Partisans are also divided on other attitudes and behaviors, with larger shares of Democrats than Republicans expressing worry, saying their lives have been disrupted, and to report taking various precautionary measures.

Precautions and Preparations

many report taking various measures to prepare FOR or protect against coronavirus, with few differences across age and health status but large partisan differences

About two-thirds of people report taking some type of precaution or making some type of preparation in reaction to the coronavirus outbreak. Most commonly, 42% say they decided not to travel or changed travel plans (up from 13% in the February KFF Health Tracking Poll), 40% say they canceled plans to attend large gatherings, and 35% say they stocked up on items like food, household supplies, or medications. One quarter (26%) say they stayed home instead of going to work, school, or other activities. Twelve percent say they bought or wore a protective mask, which is currently recommended only for those who are sick.

Figure 1: Many Report Various Measures In Reaction To Coronavirus Outbreak

The survey was in the field over a period of five days (March 11-15), during which social distancing measures were being put into place across the country. Some of these precautions were more commonly reported among those who took the survey later in the field period. For example, among those who took the survey between March 13-15, 49% say they canceled plans to attend large gatherings, 47% say they changed travel plans, and 33% say they stayed home instead of going to work or regular activities.

Some people report being unable to get different types of supplies as a result of the outbreak, including about four in ten (42%) who say they were unable to get cleaning supplies or hand sanitizer, 19% who were unable to get groceries (rising to 30% among those who took the survey between March 13-15), and 4% who were unable to get prescription medications.

Figure 2: Many Report Being Unable To Get Supplies Due To Coronavirus

Older people and those who live in a household where someone has a serious health condition are not more likely than other groups to report taking various precautions, even though they are among the groups most at risk of developing serious complications if infected with coronavirus1 .

Instead, there is a large partisan difference in the share who report taking precautions, with Democrats more likely than Republicans to say they changed travel plans (53% vs. 29%) or canceled plans to attend large gatherings (49% vs. 28%). Overall, eight in ten Democrats and about half of Republicans (53%) report taking at least one of these precautions.

Figure 3: Similar Shares Report Taking Precautions Regardless Of Age Or Chronic Condition Status In Household
Figure 4: Democrats More Likely Than Republicans To Report Taking Coronavirus Precautions

Despite widespread reports of the limited availability of testing for coronavirus, two-thirds of adults think they would be able to get a test if they needed one. Just over half of Democrats (53%) think they would be able to get a test if needed, compared to about two-thirds of independents (65%) and nearly three-fourths of Republicans (73%).

Figure 5: About Half Of Democrats Think They Would Be Able To Get Test For Coronavirus, Compared To Three In Four Republicans

Experiences and Worries

FOUR in ten say their life has been disrupted by the outbreak

Overall, 40% of the public says their life has been disrupted at least “some” by the coronavirus outbreak, including 16% who say it has been disrupted “a lot.” Among those answering the survey between March 13-15, half (50%) say their life was disrupted, including 22% who said it was disrupted “a lot.” Those most likely to say their life was disrupted include Hispanics (50%), women (46%), and parents of children under age 18 (45%).

Figure 6: Women, Parents, Hispanic Adults Most Likely To Report Life Disruption From Coronavirus

There is also a partisan difference in the share reporting life disruption from the coronavirus, with about half of Democrats (49%) compared to three in ten Republicans (30%) saying their lives have been disrupted “a lot” or “some.”

Table 1: Self-Reported Life Disruption from Coronavirus by Party Identification
How much, if at all, has your life been disrupted by the coronavirus outbreak?Party ID
TotalDemocratsIndependentsRepublicans
A lot/Some (NET)40%49%40%30%
A lot16%18%17%14%
Some24%31%24%17%
Just a little/None (NET)59%51%60%70%
Just a little29%29%27%31%
None31%22%32%39%

BIGGEST PERSONAL WORRY IS ABOUT A FAMILY MEMBER GETTING SICK, with large shares also worrying about lost income or savings

Large shares of the public report being worried about various potential impacts of coronavirus in their own lives. Most commonly, 62% say they are “very” or “somewhat” worried that they or a family member will get sick from coronavirus. About half also express financial worries, including that their investment savings will be negatively impacted (51%, rising to 61% among those with annual incomes over $90,000) or that they’ll lose income due to a workplace closure or reduced hours (46%). Just over a third (36%) worry they won’t be able to afford testing or treatment for coronavirus if they need it, including 64% of Hispanics and 66% of adults ages 18-64 without health insurance. A similar share (35%) of adults overall worry they will put themselves at risk of exposure to coronavirus because they can’t afford to stay home and miss work.

Figure 7: Personal Worries About Coronavirus Include Family Member Getting Sick, Various Economic Impacts

There are large partisan difference in worries about the coronavirus. Nearly three-quarters of Democrats (73%) say they are “very” or “somewhat” worried that they or someone in their family will get sick from the virus, compared with half of Republicans. Democrats are also much more likely than Republicans to worry about loss of job-related income (54% vs. 27%), being unable to afford coronavirus testing or treatment (46% vs. 16%), and putting themselves at risk of exposure because they can’t afford to miss work (43% vs. 20%).

Figure 8: Democrats More Likely Than Republicans To Worry About Negative Consequences Of Coronavirus

Parents of children under age 18 (68%) are more likely than others to say they’re worried that someone in their family will get sick from coronavirus, as are Hispanics (83%) and those with incomes under $40,000 (68%).

Adults under age 60 are only slightly more likely than those ages 60 and older to worry about themselves or a family member getting sick (65% vs. 56%). Although those with serious health conditions are at higher risk for complications of coronavirus, those who have a chronic condition themselves of live in a household with someone who does are not significantly more likely to worry about themselves or a family member getting sick compared to those who say no one in their household has such a condition (65% vs. 61%).

Figure 9: Parents, Hispanic Adults, And Those With Lower Incomes More Likely To Worry About Family Member Getting Sick

These worries are taking a toll for some. About a third of adults overall (32%) feel that worry and stress related to coronavirus has had a negative impact on their mental health, including 14% who say it has had a “major” impact.

Figure 10: One-Third Report Feeling Negative Mental Health Effects From Worry About Coronavirus

LOW-INCOME, HOURLY, AND PART-TIME WORKERS ARE PARTICULARLY WORRIED, AND PARTICULARLY VULNERABLE TO ECONOMIC CONSEQUENCES

Work-related worries vary by people’s employment status. About half (53%) of those who are employed say they are very or somewhat worried that they will lose income due to a workplace closure or reduced hours because of coronavirus, rising to 73% of workers with household incomes less than $40,000, 68% of those who work part-time, 61% of those who are payed by the job, 60% of those who are paid by the hour, and 60% of those who are self-employed.

Four in ten workers (41%) express worry that they will put themselves at risk of exposure to coronavirus because they can’t afford to stay home and miss work, a worry that is highest among lower-income workers (60%), part-time workers (49%), and those paid by the hour (46%) or by the job (43%). Among those who say they or someone in their household works in a health care delivery setting, a group at higher risk for coronavirus exposure, 40% say they worry about putting themselves at risk because they can’t afford not to work.

Table 2: Employment-Related Worries Related to Coronavirus
Percent who are very or somewhat worried that they will…HoursCompensationHousehold incomeEmployer
Total employedFull-timePart-timeSalaryHourlyBy the job<$40K$40 to <$90K$90K+Self-employedWork for someone else
Lose income due to a workplace closure or reduced hours because of coronavirus53%50%68%38%60%61%73%52%41%60%52%
Put themselves at risk of exposure to coronavirus because they can’t afford to and miss work41%39%49%30%46%43%60%38%28%37%42%

One in ten employed adults report that they have already lost income from a job or business because of coronavirus. This share rises to about one-quarter (23%) among those who are self-employed, 21% of those who are paid by the job, and 18% of part-time workers.

Figure 11: One In Ten Workers Report Lost Income From Work Or Business, Including One-Quarter Of Self-Employed And Contract Workers

As social distancing measures have been put in place across the country, many employers have asked or required all or part of their workforce to work from home. About half of those who are employed (45%) say they can do at least part of their job from home, but the share is much lower among lower-income workers (29%), part-time workers (32%), hourly workers (25%).

Most workers overall (64%) say their employer offers them paid time off if they are sick or ill, and about four in ten (43%) say their employer offers them paid time off to care for an ill family member. This leaves about one-third (32%) who say they do not get paid sick leave and about half (51%) who say they do not get paid family leave.

Those who work part-time, workers who are paid hourly or by the job, and those with lower incomes are much less likely to report having paid leave of any type. A recent KFF analysis provides more detail on how paid leave policies vary by state, average wage level, and employer size and discusses the implications for workers.

Table 3: Remote Work and Paid Leave
Among those who are employedTotal employedHoursCompensationHousehold income
Full-timePart-timeSalaryHourlyBy the job<$40K$40 to <$90K$90K+
Percent who say if required to remain at home because of a quarantine or school or work closure, they could do at least part of their job from home45%48%32%79%25%47%29%42%63%
Percent whose employer offers them paid time off if they are sick or ill64%70%38%86%61%25%51%69%70%
Percent whose employer offers them paid time off to care for a family member who is sick or ill43%48%18%66%36%17%31%42%56%

PARENTS FACING SCHOOL CLOSURES ARE PARTICULARLY LIKELY TO SAY THEIR LIVES HAVE BEEN DISRUPTED

Among parents of children under age 18, nearly half (45%) say their lives have been disrupted at least “some” by the coronavirus outbreak. Among those who say their child’s school or daycare has closed as a result of the outbreak, two-thirds (66%) say their lives have been disrupted, including 36% who say they’ve been disrupted “a lot.” About a third of parents (36%) in the survey overall say their child’s school or daycare has closed for some amount of time, a share that increased sharply throughout the survey field period. Among parents answering the survey between March 13-15, 63% say their child’s school or daycare had closed.

While most parents say it would not be difficult to find alternative childcare if their child’s school or daycare closed for 2 weeks or more, about one-third say it would be “very” or “somewhat” difficult. Those most likely to say it would be difficult include parents with household incomes less than $40,000 (46%), and working parents who do not get paid family leave (45%) or are paid by the hour or the job (42%).

Table 4: Alternative Childcare Issues Among Parents
If your child’s school or daycare was closed for two weeks or more due to coronavirus, how difficult, if at all, would it be for you to find alternative childcare?Total parentsHousehold incomePaid family leave?Compensation
<$40K$40K or moreYesNoPaid hourly or by job
Difficult (NET)33%46%27%27%45%42%
Very difficult19%29%13%11%28%24%
Somewhat difficult14%17%14%16%18%18%
Not difficult (NET)61%50%67%67%48%52%
Not too difficult15%13%14%19%12%12%
Not at all difficult47%36%53%48%36%40%
Not applicable/child doesn’t require childcare5%4%5%5%6%6%

Knowledge and Sources of Information

Public mostly knows key facts about coronavirus, though some gaps in knowledge remain

Overall, large majorities of the public are aware of key information about prevention, transmission, risk, and treatment of coronavirus. However, sizeable shares hold some misconceptions that could potentially lead to confusion about how to identify symptoms or what to do if they or someone in their household becomes ill.

Overwhelming majorities, across partisans and demographic groups, know that frequent handwashing, staying home if you are sick, and avoiding large gatherings are recommended by public health experts as a way to help slow the spread of coronavirus. Nine in ten are aware that coronavirus can be transmitted by being in close proximity with someone who is infected and by touching surfaces that contain small amounts of bodily fluids from an infected person.

The public is also generally knowledge about the symptoms of coronavirus, as 95% know that a fever is a common symptom of the virus and 80% know that a dry cough is a common symptom. Overwhelming majorities know that adults ages 60 or older and those with pre-existing medical conditions are at a higher risk of developing serious medical complications from the coronavirus (96% and 98% respectively). About nine in ten (89%) are aware that there currently is no vaccine for coronavirus, and a similar share (86%) knows that the seasonal flu vaccine does not provide protection from the coronavirus.

However, there remain some notable knowledge gaps which may lead to confusion about when to seek care or testing or who is most at risk. For example, a majority of adults (56%) think nasal congestion is a common symptom of coronavirus. However, according to data reported by the World Health Organization, nasal congestion was present in only 5% of coronavirus cases in China.2  Similarly, four in ten adults mistakenly think children are at a higher risk of developing serious medical issues due the coronavirus, including 39% of parents. Thus far, however, children do not appear to be a higher risk.3 

Table 5: Public Knowledge About Various Aspects Of Coronavirus
Large shares get many facts right…But some knowledge gaps remain…
Recommendations to slow spread of coronavirus
Between 88%-97% know that frequent handwashing, staying home if feeling sick, and avoiding large gatherings are recommended25% think it is recommended for health people to wear masks in public
How coronavirus is transmitted
Nine in ten know transmission occurs through close physical proximity (90%) or touching surfaces that contain small amounts of bodily fluids from someone who is infected (91%)12% think coronavirus is transmitted through mosquito bites
Common symptoms
Large majorities recognize fever (95%) and dry cough (80%) as common symptoms, and 85% know that rash is not a symptom56% think nasal congestion is a common symptom of coronavirus
Who is at most risk of serious complications
Nearly everyone recognizes that people with chronic health conditions (98%) and those over the age of 60 (96%) have a higher risk of developing serious medical issues if they become infected40% think children are at higher risk
What happens to most people infected
65% recognize that most people infected with coronavirus recover without serious complications23% think most people develop serious complications that require intensive care.
Vaccine
89% know there is no vaccine for COVID-19, and 86% know that the flu vaccine doesn’t protect against it

While most adults (73%) know that someone who thinks they are experiencing symptoms of coronavirus should stay home and call a doctor or medical provider, one in four (25%) think that someone experiencing symptoms should seek immediate care at an emergency room or urgent care facility, including 38% of lower-income adults and 39% among those ages 18-64 who are uninsured.

Figure 12: About Four In Ten Lower-Income Adults Say Those With Symptoms Should Seek Immediate Care At An ER Or Urgent Care Facility

most feel they have enough information TO PROTECT THEMSELVES, with cdc and who most trusted sources

About eight in ten adults (83%) say they feel they have enough information about how to protect themselves and their family from coronavirus while 16% say they don’t have enough information. The share who feel they don’t have enough information is somewhat higher among adults who are Black (25%) or Hispanic (22%), and those with a high school education or less (20%).

More than eight in ten adults (85%) say they trust the U.S. Center for Disease Control and Prevention (CDC) as a source for reliable information on coronavirus. More than three in four (77%) trust the World Health Organization (WHO) as a reliable source of information, while seven in ten trust their local government officials (70%) or their state government officials (71%). Fewer say they trust the news media (47%) and President Trump (46%) as a reliable source of information on coronavirus.

Figure 13: Most Trust The CDC And WHO As Sources Of Information While Half Trust The News Media And President Trump

There are some notable partisan differences on who the public trusts as reliable sources of information. While 88% of Republicans have a great deal or a fair amount of trust in President Trump to provide reliable information about coronavirus, 80% of Democrats say they have not much or no trust in the President. Notably, Democrats are more likely than Republicans to trust the news media to provide reliable information (69% vs. 29%).

Trust for both the CDC and WHO is high across partisan groups. Similar shares of Democrats (85%) and Republicans (90%) trust the CDC to provide reliable information about the virus, but Democrats are somewhat more likely than Republicans to trust the WHO (90% vs 71%).

Table 6: Trust In Sources of Coronavirus Information By Party Identification
Percent who say they trust each of the following a great deal or a fair amount to provide reliable information on coronavirus:TotalParty ID
DemocratsIndependentsRepublicans
The U.S. Centers for Disease Control and Prevention, or CDC85%85%85%90%
The World Health Organization, or WHO77%90%75%71%
State government officials71%80%67%72%
Local government officials70%77%65%74%
The news media47%69%41%29%
President Trump46%19%42%88%

More generally, when it comes in their level of trust in presidential candidates to handle public health emergencies like the coronavirus outbreak, about four in ten adults overall say they trust President Donald Trump (44%), Joe Biden (44%), and Bernie Sanders (41%) “a great deal” or “a fair amount.” There is a large partisan divide, with 86% of Republicans expressing at least a fair amount of trust in President Trump compared with 20% of Democrats. Among Democrats, at least seven in ten trust both Joe Biden (76%) and Bernie Sanders (70%) to handle a public health emergency.

Table 7: Trust In Trump, Sanders, and Biden to Handle Public Health Emergencies
How much do you trust each of the following to handle public health emergencies like the current coronavirus outbreak?TotalParty ID
DemocratsIndependentsRepublicans
Donald Trump
A great deal/a fair amount44%20%40%86%
Not much/Not at all51%79%53%11%
Bernie Sanders
A great deal/a fair amount41%70%41%13%
Not much/Not at all48%23%47%80%
Joe Biden
A great deal/a fair amount44%76%39%20%
Not much/Not at all45%18%49%74%

 

Methodology

This KFF Coronavirus Poll was designed and analyzed by public opinion researchers at the Kaiser Family Foundation (KFF). The survey was conducted March 11th -15th, 2020, among a nationally representative random digit dial telephone sample of 1,216 adults ages 18 and older, living in the United States, including Alaska and Hawaii (note: persons without a telephone could not be included in the random selection process). Computer-assisted telephone interviews conducted by landline (246) and cell phone (970, including 702 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 2018 American Community Survey (ACS) on sex, age, education, race, Hispanic origin, and region 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 July-December 2018 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 prepaid cell phones and 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.

GroupN (unweighted)M.O.S.E.
Total1,216±3 percentage points
Party Identification
Democrats356±6 percentage points
Republicans310±6 percentage points
Independents380±5 percentage points
Age
18-39424±5 percentage points
40-59373±5 percentage points
60-74256±7 percentage points
75 and older136±10 percentage points
60 and older392±5 percentage points

Endnotes

  1. U.S. Centers for Disease Control and Prevention. (March 2020). Coronavirus Disease 2019 (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html ↩︎
  2. World Health Organization. (March 2020). Report of the WHO-China Joint Mission on Coronavirus Disease 2019. https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf ↩︎
  3. U.S. Centers for Disease Control and Prevention. (March 2020). Coronavirus Disease 2019 (COVID-19) and Children. https://www.cdc.gov/coronavirus/2019-ncov/prepare/children-faq.html ↩︎

What Issues Will Uninsured People Face with Testing and Treatment for COVID-19?

Published: Mar 16, 2020

With COVID-19 cases rising in the US, issues surrounding access to testing and treatment for uninsured individuals have taken on heightened importance. Efforts to limit the spread of the coronavirus in the United States are dependent on people who may have been exposed to the virus or who are sick getting tested and seeking medical treatment. However, the uninsured are likely to face significant barriers to testing for COVID-19 and any care they may need should they contract the virus.

In 2018, there were nearly 28 million nonelderly people in the US who lacked health insurance. States that have not expanded Medicaid under the ACA generally have higher uninsured rates than states that did. Adults, low-income individuals and people of color are at greater risk of being uninsured. Most uninsured lack coverage because of high cost or because of a recent change in their situation that led to a loss of coverage, such as a loss of a job. Though most uninsured people have a full time worker (72%) or part-time worker (11%) in their family, many people do not have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for financial assistance for coverage.

Many uninsured adults work in jobs that may increase their risk of exposure to COVID-19. Most uninsured adults are working. Because of the jobs they have, uninsured workers may be at greater risk of exposure to the disease. Among the top ten occupations reported by the uninsured, many are service-oriented, such as drivers, cashiers, restaurant servers and cooks, and retail sales that cannot be performed through telework and bring the uninsured into regular contact with the public (Figure 1). In addition, data analysis finds that nearly six million adults who are at higher risk of getting a serious illness if they become infected with coronavirus are uninsured.

Figure 1: Occupations with the Largest Numbers of Uninsured Workers, 2018

Uninsured workers who must take off work because they or family members are sick could face significant financial consequences. The U.S. does not have a federal law guaranteeing paid sick leave, and only 11 states and DC currently require paid sick leave. The burden of the lack of paid sick leave falls more heavily on low-wage and uninsured workers. In 2018, just over a quarter (26%) of uninsured workers said they had paid sick leave. Facing the risk of not getting paid or possibly losing their position if they do not show up for work, uninsured workers who are not provided sick leave may be reluctant to take time off, which could put their health at risk and could undermine efforts to control the spread of coronavirus.

Congress enacted legislation that would require certain employers to provide paid sick leave during this public health crisis; however, this new policy will not reach all uninsured workers. Under the emergency paid sick leave provisions in the Families First Coronavirus Response Act, workers in all public agencies as well as at some private firms with between 50 and 500 employees must be compensated at least a portion of their regular pay for 14 days if they take time off to address health needs for themselves or family members or to care for children due to school closures. If workers need more than 14 days off work to care for children due to school closures, they may be able to obtain up to 2/3 of their typical compensation for up to three months, but this policy does not extend to all workers and excludes employees at businesses with more than 500 employees. These new leave policies take effect two weeks after enactment of the legislation and the benefits are not retroactive, which means that uninsured workers who already took leave due to coronavirus would not be compensated for that time.

Barriers to COVID-19 Testing and Treatment

People who are uninsured will likely face unique barriers accessing COVID-19 testing and treatment services. Over half of the uninsured do not have a usual place to go when they need medical care, and one in five uninsured adults in 2018 went without needed medical care due to cost (Figure 2). Studies repeatedly demonstrate that uninsured people are less likely than those with insurance to receive services for major health conditions and chronic diseases. Without a usual source of care, the uninsured may not know where to go to get tested if they think they have been exposed to the virus and may forego testing or care out of fear of having to pay out-of-pocket for the test. The Emergency Medical Treatment and Labor Act requires hospitals to screen and stabilize patients with emergent conditions, however, they are not required to provide the care at no cost for patients who cannot pay, and they are not required to provide treatment for non-emergent conditions. As a result, uninsured individuals are less likely to use the emergency department than people with insurance, and the high costs of ED care may dissuade those without coverage from seeking care in that setting.

Figure 2: Barriers to Health Care among Nonelderly Adults by Insurance Status, 2018

Uninsured individuals who contract COVID-19 and need medical care will likely receive large medical bills, even if they have low incomes and are unable to pay. When uninsured individuals need medical care, the costs can be prohibitive. Uninsured people pay the full cost of care, often at higher rates than those with insurance whose coverage may negotiate lower rates than a hospital otherwise charges. While some uninsured can get care at community health centers and other safety net providers, these providers have limited resources and capacity, and not all uninsured have geographic access to a safety net provider. Because the U.S. lacks a comprehensive hospital charity care policy, uninsured individuals who use hospital care will be billed for the services. Uninsured individuals who meet certain criteria may qualify for a hospital’s charity care program to reduce any hospital bills; however, not all hospitals are required to offer charity care programs, and among those that do, the eligibility criteria can vary widely. Fear of large and unaffordable medical bills can deter uninsured individuals from getting the care they need. In the context of a public health emergency, decisions to forego care because of costs can have devastating consequences.

Options for Reducing Barriers to COVID-19 Testing and Treatment

Federal legislation enacted in response to the coronavirus crisis ensures free testing for uninsured individuals. The Families First Coronavirus Response Act signed into law on March 18, 2020 includes a provision that gives states the option to expand Medicaid coverage to uninsured individuals in their state to provide coverage for COVID-19 diagnosis and testing with 100% federal financing. Although the coverage is limited to testing services, it will ensure more uninsured can access free testing, since the legislation also requires state Medicaid programs to cover diagnosis and testing for COVID-19 with no cost sharing. The legislation also appropriates $1 billion to the National Disaster Medical System to provide reimbursement to providers for the costs associated with diagnosis and testing of uninsured individuals. However, the legislation does not address coverage of COVID-19 treatment costs for people who are uninsured.

While the federal legislation will reduce barriers to COVID-19 testing, additional steps will be required to reduce barriers to accessing treatment for uninsured individuals who get sick. Expanding comprehensive coverage options to the uninsured would facilitate access to COVID-19 treatment for those who need it. Decisions by states that have not yet adopted the Medicaid expansion to do so would provide eligibility for coverage to the 2.3 million nonelderly uninsured adults in the coverage gap. In addition to adopting the Medicaid expansion, the federal government could provide flexibility to states to use Medicaid Section 1115 waiver and/or Section 1135 waiver authority to cover individuals who would not otherwise be eligible for coverage during the public health crisis, and potentially beyond. These waivers have been used in past emergencies to expand coverage. Additionally, states that operate their own health insurance marketplaces could provide a special enrollment period (SEP) in response to the coronavirus outbreak to allow uninsured individuals to enroll in coverage. Washington, Massachusetts, and Maryland recently announced coronavirus-related SEPs for uninsured residents. The federal government could also establish a national special enrollment period that would apply across all states, allowing many more uninsured to sign up for coverage.

In lieu of expanding coverage, providing funding to providers to expand COVID-19 services to uninsured individuals or to reimburse them for uncompensated costs they incur could also facilitate access to needed care. The supplemental appropriations legislation to finance the response to coronavirus included $100 million to community health centers to support increased access to testing and primary care services in medically underserved areas. However, this funding does not address costs to hospitals for treatment of infected individuals. Congress could appropriate additional funds to cover hospital costs related to treating uninsured individuals who contract the disease and need hospital care. Programs such as the National Disaster Medical System (NDMS) or Disproportionate Share Hospital (DSH) program could be used to reimburse hospitals for uncompensated costs; however, additional funding would be needed to cover the treatment costs related to COVID-19. Democratic Presidential candidate, Joe Biden, has proposed utilizing the NDMS by expanding its authority to reimburse providers for the costs of testing, treatment, and vaccines associated with COVID-19 for uninsured individuals and by providing full funding of those costs.

Potential Costs of Coronavirus Treatment for People with Employer Coverage

Authors: Matthew Rae, Gary Claxton, Nisha Kurani, Daniel McDermott, and Cynthia Cox
Published: Mar 16, 2020

As COVID-19 spreads within the United States, questions have arisen over the potential costs people may face if they become severely ill and need treatment. While many large insurers have agreed to waive copayments and deductibles for COVID-19 tests, people with private insurance who face deductibles could still be on the hook for large treatment costs.

A new brief examines the potential cost of COVID-19 treatment to employer health plans and their enrollees by looking at typical spending for hospital admissions for pneumonia. It finds that for coronavirus patients with complications or comorbidities, treatment costs could top $20,000. Average out-of-pocket costs could exceed $1,300 for all admitted patients, including those without complications or comorbidities.

The analysis also estimates the likelihood of unexpected out-of-network charges (“surprise medical bills”) for coronavirus treatment, and finds that nearly 1 in 5 patients who have in-network admissions for pneumonia with major complications or comorbidities face out-of-network charges.

The analysis is part of the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

For more data, analysis, polling and journalism on the COVID-19 pandemic, visit our special resource page on kff.org.

News Release

New Analysis Finds Inpatient Coronavirus Treatment Costs Could Top $20K for Patients with Employer Coverage

Published: Mar 16, 2020

A new issue brief estimates potential coronavirus treatment costs to large employer health plans and their enrollees by looking at typical spending for hospital admissions for pneumonia. The analysis finds that, for pneumonia admissions with major complications and comorbidities, the average total cost is $20,292. In comparison, the average cost for a patient with no complications or comorbidities is $9,763.

Average out-of-pocket costs could exceed $1,300 for all admitted patients, including those without complications or comorbidities.

While complications and deaths associated with the novel coronavirus (COVID-19) are concentrated among older adults, who will have different estimated costs under Medicare, many younger patients are expected to become seriously ill as the pandemic spreads in the United States. Those covered by employer-sponsored plans can expect to have copayments and deductibles associated with coronavirus testing waived by their insurers, but will still be responsible for the out-of-pocket costs associated with their treatment.

The analysis is part of the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

For more data, analysis, polling and journalism on the COVID-19 pandemic, visit our special resource page on kff.org.

News Release

About 4 in 10 Adults in the U.S. Are At Greater Risk of Developing Serious Illness if Infected with Coronavirus, Due to Age or Underlying Health Conditions 

5.7 million Are Uninsured; State-Level Data Shows the Share at Higher Risk Varies By State

Published: Mar 13, 2020

Based on current understanding of risk, forty-one percent of adults ages 18 and older in the U.S. have a higher risk of developing more serious illness if they become infected with the virus that causes COVID-19, because they are older or have serious underlying health conditions, or both, according to a new KFF analysis.

Of the more than 105 million adults at higher risk if infected with coronavirus, most – 76.3 million, or 72 percent – are age 60 or older, the analysis finds. However, the remaining 29.2 million adults in this group are ages 18-59 and are at higher risk if infected due to an underlying medical condition such as heart disease, cancer, chronic obstructive pulmonary disease (COPD) or diabetes.

Nearly 6 million people at higher risk are uninsured, including 3.9 million adults under age 60 and 1.8 million who are ages 60-64. (Virtually all adults ages 65 and older are covered by Medicare.)

The share of adults at higher risk of serious illness if infected with the virus varies across the country, ranging from 31 percent in Washington D.C. to 51 percent in West Virginia. In Washington State, California and New York, some of the states hardest hit by COVID-19 so far, the share of adults at higher risk is 40 percent, 37 percent and 40 percent, respectively.

“A large share of adults have underlying conditions that put them at risk of getting more seriously ill if they get infected with coronavirus, which is why extraordinary measures are so critical,” said KFF President and CEO Drew Altman. “They are not all seniors — twenty nine million are under sixty, and a large group – approximately 5.7 million – are uninsured,” he added.

The Centers for Disease Control and Prevention has issued guidance for people at higher risk of serious illness, advising them to avoid crowds, cruises and non-essential air travel, and to stay home as much as possible to further reduce their risk of being exposed. Information from the World Health Organization cautions that older people and those with underlying medical conditions are at higher risk of getting severe COVID-19 disease.

KFF researchers analyzed data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) to estimate the total number of adults nationwide, and by state, with an elevated risk of serious illness if infected because of their age or underlying health condition, based on the current information made available by CDC.

The analysis defines older adults as individuals ages 60 or older. Younger adults, ages 18-59, are defined as at “at risk” if they get infected with coronavirus and have heart disease, cancer, chronic obstructive pulmonary disease (COPD) or diabetes, although researchers recognize that risk factors, including age, are evolving as the disease spreads and more is learned about its effects on different populations.

For more data and analysis related to the COVID-19 crisis, including a look at how the coronavirus might affect residents in nursing facilities, visit kff.org.

Data Note: How might Coronavirus Affect Residents in Nursing Facilities?

Published: Mar 13, 2020

Introduction

While knowledge about COVID-19 continues to evolve daily, experts agree that certain populations are particularly vulnerable to severe cases of the infection – those with chronic conditions, compromised immune systems, and of old age. Nursing facilities provide care to populations with those characteristics, and residents in these facilities are particularly at risk of developing serious illness or dying if infected. In 2017, there were approximately 1.3 million residents receiving care across 15,483 nursing facilities in the US (Table 1). This data note provides key data points to highlight the potential implications of COVID-19 on nursing facility residents and overall operations.

Share of nursing home residents receiving respiratory treatment

Many residents in nursing facilities have underlying respiratory issues and may be at particular risk of illness should they contract coronavirus. One common symptom of coronaviruses is respiratory illness. About 16 percent of all residents in nursing facilities across the US received respiratory treatment in 2017, which includes using respirators/ventilators, oxygen, inhalation therapy, and other treatment. Given the implications of this virus on respiratory systems, these residents could be at higher risk of severe outcomes if they were to become infected. In states such as Colorado and Utah, over 30% of residents in nursing facilities are receiving respiratory treatment (Table 1). Ventilator supply is also crucial to consider, given the increased demand for this equipment for those severely impacted by COVID-19.

Share of nursing home residents with depression

Anxiety and depression are also common among nursing facility residents, and these health problems may be exacerbated by fear, worry, or social isolation due to COVID-19. Residents in nursing facilities are at risk of being diagnosed with psychiatric disorders, with nearly 40% having experienced symptoms of depression (Table 1). In Washington, where media attention has been centered on the outbreak of coronavirus in nursing facilities, almost half of residents have experienced depression or depressive symptoms. Research on family involvement in long-term care has shown that family visitation can have potentially positive effects on cognitive and behavioral health diagnoses.1  Thus, visitor restrictions in nursing facilities, which are currently being implemented to lower the risk of exposure among residents who would be vulnerable to illness if infected, may also have negative impacts on residents’ mental health and increase the incidence of depressive symptoms.2 

Share of nursing homes with deficiencies in infection control

Deficiencies related to the spread of infectious disease are relatively common in nursing facilities, with nearly 40% of facilities having at least one infection control deficiency in 2017 (Table 1). Deficiencies related to infection control are the most common deficiency that nursing facilities report, followed by food sanitation (36%) and accident environment (34%). In Delaware, Mississippi, Missouri, Illinois, Michigan, and California, over half of facilities reported at least one deficiency related to infection control (Table 1 and Figure 1). Given the importance of following infection control procedures in mitigating the spread of the virus, facilities that have historically reported infection control deficiencies could be at elevated risk of a COVID-19 outbreak.

Figure 1: States with high shares of nursing homes with deficiencies related to spread of infection

Occupancy rates in nursing homes

Resident density could have an impact on how fast an outbreak of COVID-19 might spread in a particular facility. Nationally, four of every five nursing facility beds were filled in 2017, with some states such as New York and DC reporting even higher occupancy density (over 90%) (Table 1). Higher occupant density puts residents at risk of quicker spread.

In the early stages of the COVID-19 epidemic in the U.S., residents in nursing facilities have been affected more than any other group and account for a large share of deaths. These residents’ physical and mental health conditions, facilities’ abilities to deal with infectious disease, and occupancy rates are all important considerations when thinking about addressing the spread of COVID-19 in nursing homes and other vulnerable populations.

Table 1: COVID-19 Related Nursing Home Data Indicators
StateTotal number of nursing facilitiesTotal number of nursing facility residentsShare of residents in facilities receiving respiratory treatmentShare of residents in facilities with depressionShare of facilities with deficiencies related to infectious disease controlFacility occupancy rate
Alabama22822,48218%31%48%84%
Alaska1860812%35%33%88%
Arizona14511,34323%31%22%70%
Arkansas23117,43918%32%39%71%
California1198101,03016%23%63%85%
Colorado22116,07832%45%42%78%
Connecticut22322,65316%34%31%85%
Delaware454,18115%32%51%87%
Dist. of Columbia182,38014%24%39%92%
Florida69072,74117%32%42%87%
Georgia35933,04314%41%19%83%
Hawaii423,47410%24%43%85%
Idaho713,31928%49%49%63%
Illinois73166,64314%52%56%74%
Indiana55238,68215%41%35%73%
Iowa43723,63815%46%22%77%
Kansas27614,65718%47%34%77%
Kentucky28522,76020%36%37%85%
Louisiana27726,16912%26%29%77%
Maine1005,94713%49%15%87%
Maryland22624,41414%37%40%87%
Massachusetts39938,67311%38%30%84%
Michigan44338,06216%34%58%81%
Minnesota37524,75515%46%40%86%
Mississippi20415,95012%27%51%88%
Missouri51837,87416%38%52%70%
Montana724,15320%43%42%65%
Nebraska21411,39418%50%31%72%
Nevada615,33627%29%38%76%
New Hampshire746,44215%41%26%87%
New Jersey36444,03316%25%31%84%
New Mexico745,69324%39%36%79%
New York609101,51814%38%20%90%
North Carolina42935,76316%33%17%81%
North Dakota805,53115%51%34%91%
Ohio96673,82617%52%28%82%
Oklahoma30318,36118%42%30%64%
Oregon1367,31717%32%33%65%
Pennsylvania69376,65218%36%46%87%
Rhode Island837,8179%44%5%90%
South Carolina19116,99314%31%21%86%
South Dakota1085,98418%54%43%90%
Tennessee31426,48119%35%31%73%
Texas1,22792,25012%37%48%69%
Utah995,17832%48%43%63%
Vermont362,44014%49%14%79%
Virginia28627,59518%35%38%86%
Washington21715,99317%46%43%77%
West Virginia1239,25118%40%42%87%
Wisconsin37424,23915%45%38%77%
Wyoming382,42829%47%47%82%
US TOTAL15,4831,321,66316%37%39%80%
SOURCES: KFF analysis of 2017 OSCAR/CASPER nursing facility data
  1. Gaugler, Joseph E. “Family involvement in residential long-term care: A synthesis and critical review.” Aging & mental health 9.2 (2005): 105-118. ↩︎
  2. Vernon L. Greene, PhD, Deborah J. Monahan, MA, The Impact of Visitation on Patient Well-Being in Nursing Homes, The Gerontologist, Volume 22, Issue 4, August 1982, Pages 418–423 ↩︎

The U.S. Response to Coronavirus: Summary of the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020

Published: Mar 11, 2020

The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (P.L. 116-123), which passed with near unanimous support in both the House and Senate, was signed into law by the President on March 6, 2020. The bill provides $8.3 billion in emergency funding for federal agencies to respond to the coronavirus outbreak. Of the $8.3 billion, $6.7 billion (81%) is designated for the domestic response and $1.6 billion (19%) for the international response. Key highlights are below. Additional details on specified activities and expenditure period are provided in Table 1:

Domestic Efforts:

Of the $6.7 billion designated for the domestic response:

  • The majority ($6.2 billion) is for the Department of Health and Human Services (HHS) including:
    • $3.4 billion for the Office of the Secretary – Public Health and Social Services Emergency Fund (PHSSEF), which includes more than $2 billion for the Biomedical Advanced Research and Development Authority (BARDA) (for the research and development of vaccines, therapeutics, and diagnostics), $300 million in contingency funding for the purchase of vaccines, therapeutics, and diagnostics to be used if deemed necessary by the Secretary of HHS, and $100 million for the Health Resources and Services Administration (HRSA) for grants under the Health Center Program, which aims to improve health care to people who are geographically isolated and economically or medically vulnerable.
    • $1.9 billion for the Centers for Disease Control and Prevention (CDC), which includes $950 million for state and local response efforts, of which $475 million must be allocated within 30 days of the enactment of the bill, and $300 million for the replenishment of the Infectious Diseases Rapid Response Reserve Fund, which supports U.S. efforts to respond to an infectious disease emergency.
    • $836 million for the National Institute of Allergy and Infectious Diseases (NIAID), which conducts research on therapies, vaccines, diagnostics, and other health technologies, at the National Institutes of Health (NIH).
    • $61 million for the Food and Drug Administration (FDA) for the development and review of vaccines, therapeutics, medical devices and countermeasures, address potential supply chain interruptions, and support enforcement of counterfeit products.
  • $20 million is for the Small Business Administration (SBA) disaster loans program to support SBA’s administration of loan subsidies that will be made available to entities financially impacted as a result of the coronavirus.
  • The bill also includes a waiver removing restrictions on Medicare providers allowing them to offer telehealth services to beneficiaries regardless of whether the beneficiary is in a rural community, at an estimated cost of $500 million.

It is possible that some of the domestic funding could be used for international efforts.

International Efforts:

Of the $1.6 billion designated for the international response:

  • The majority, $986 million, is provided to the United States Agency for International Development (USAID) including funding provided through:
    • $435 million for the Global Health Programs (GHP) account to support health systems responding to the coronavirus outbreak overseas.
    • $300 million for the International Disaster Assistance (IDA) account to support humanitarian assistance needs resulting from the coronavirus outbreak.
    • $250 million for the Economic Support Fund (ESF) account to support economic, security and stabilization efforts resulting from the coronavirus outbreak
    • $1 million for the Office of the Inspector General (OIG) for oversight of coronavirus response activities.
  • The State Department receives $264 million to support consular operations, emergency evacuations, and other needs at U.S. embassies.
  • $300 million is provided to CDC to support global disease detection and emergency response efforts.

Expenditure Period:

The bill specified that funding could be disbursed over a multi-year period, although the periods vary by agency and account. For instance, Congress specified funding provided through the CDC “to remain available until September 30, 2022,” funding provided through the FDA “to remain available until expended,” and funding provided through NIAID “to remain available until September 30, 2024.”

Table 1: Coronavirus Supplemental Funding
Agency/Department/AccountTotal FundingExpenditure PeriodDescription
Domestic Response
Department of Health and Human Services (HHS)$6,197,000,000 – –
Office of the Secretary Public Health and SocialServices Emergency Fund$3,400,000,000“to remain available until September 30, 2024”“to prevent, prepare for, and respond to coronavirus, domestically or  internationally, including the development of necessary countermeasures and vaccines, prioritizing platform-based technologies with U.S.-based manufacturing capabilities, and the purchase of vaccines, therapeutics, diagnostics, necessary medical supplies, medical surge capacity, and related administrative activities”
of which Public Health and Social Services Emergency Fund$300,000,000“to remain available until September 30, 2024”“for products purchased … including the purchase of vaccines, therapeutics, and diagnostics”
of which Health Resources and Services Administration (HRSA)$100,000,000 –” to prevent, prepare for, and respond to coronavirus” for grants under the Health Centers Program
Centers for Disease Control and Prevention*$1,900,000,000“to remain available until September 30, 2022”CDC-Wide activities and program support: “to prevent, prepare for, and respond to coronavirus, domestically or internationally”
of which$950,000,000 –“Not less than this amount shall be provided for grants to or cooperative agreements with States, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes, to carry out surveillance, epidemiology, laboratory capacity, infection control, mitigation, communications, and other preparedness and response activities”
of which Infectious Diseases Rapid Response Reserve Fund (Reserve Fund)$300,000,000 –” to replenish the Infectious Diseases Rapid Response Reserve Fund, which supports immediate response activities during outbreaks”
of which$40,000,000 –“Not less than $40,000,000 of such funds shall be allocated to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes”
National Institutes of Health (NIH) – NationalInstitute of Allergy and Infectious Diseases(NIAID)*$836,000,000“remain available until September 30, 2024”“to prevent, prepare for, and respond to coronavirus, domestically or internationally”
of which National Institute of Environmental Health Sciences (NIEHS)$10,000,000 –“for worker-based training to prevent and reduce exposure of hospital employees,  emergency first responders, and other workers who are at risk of exposure to coronavirus through their work duties”
Food and Drug Administration*$61,000,000“to remain available until expended”“to prevent, prepare for, and respond to coronavirus, domestically or international, including the development of necessary medical countermeasures and vaccines, advanced manufacturing for medical products, the monitoring of medical product supply chains, and related administrative activities.”
Small Business Administration$20,000,000 – –
Disaster Loans Program Account$20,000,000“to remain available until expended”“to make economic injury disaster loans … in response to the coronavirus”
Telehealth Services$500,000,000Not specified“to waive certain Medicare telehealth restrictions during the coronavirus public health emergency.These waivers would allow Medicare providers to furnish telehealth services to Medicarebeneficiaries regardless of whether the beneficiary is in a rural community”
Total Domestic Response$6,717,000,000 – –
International Response
USAID$986,000,000 – –
Office of Inspector General$1,000,000“to remain available until September 30, 2022”Oversight activities
Global Health Programs$435,000,000“to remain available until September 30, 2022”“to prevent, prepare for, and respond to coronavirus”
of which Emergency Reserve Fund$200,000,000“to remain available until September 30, 2022” –
International Disaster Assistance$300,000,000“to remain available until expended”“to prevent, prepare for, and respond to coronavirus”
Economic Support Fund$250,000,000“to remain available until September 30, 2022”“to prevent, prepare for, and respond to coronavirus, including to address related economic, security, and stabilization requirements”
Department of State$264,000,000 – –
Diplomatic & Consular Programs$264,000,000“to remain available until September 30, 2022”“to prevent, prepare for, and respond to coronavirus, including for maintaining consular operations, reimbursement of evacuation expenses, and emergency preparedness”
Centers for Disease Control and Prevention$300,000,000“to remain available until September 30, 2022”“global disease detection and emergency response”
Total International Response$1,550,000,000 – –
Total Coronavirus Funding$8,267,000,000 – –
NOTES: * Indicates funding that could be used both domestically and internationallySOURCES: KFF analysis of the “Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020” (P.L. 116-123); House Appropriations H.R. 6074: Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 Title-By-Title Summary.