The goals of this study were to determine the impact of Medicaid expansion and alternate approaches to expansion on inpatient and emergency department (ED) utilization and disparities in those using data from State Inpatient and ED databases, determine the impact of Affordable Care Act and Medicaid expansion on substance use disorder (SUD) treatment utilization using the National Survey of Drug Use and Health and Treatment Episode Database, and to assess the potential impacts of reducing Medicaid eligibility to Federal Poverty Level (FPL) nationwide.
A difference in difference (DID) design was used to determine the impact of Medicaid expansion and alternate approaches to expansion on rates of inpatient and ED use and a triple difference design was used to determine the impact on disparities in those. Logistic regressions were conducted to determine the impact of ACA on SUD treatment DID approach was used to determine impact of Medicaid expansion on rate of SUD treatment admissions. Logistic and Poisson regressions were used to compare healthcare utilization and access to care between Medicaid enrollees earning 100%-138% of FPL with marketplace enrollees and uninsured to determine whether transitioning the Medicaid enrollees to the marketplace might change their utilization patterns and to determine the impact of losing Medicaid insurance on access to care.
Medicaid expansion and alternate approaches to expansion had no impact on inpatient utilization, but Medicaid expansion increased the volume of ED visits. ACA increased the likelihood of treatment among SUD patients, lowered the likelihood of self-pay and increased the likelihood of Medicaid funded treatment. Medicaid expansion did not impact SUD treatment rates but increased Medicaid funded and decreased charity funded treatment. We found that shifting Medicaid enrollees to the marketplace is unlikely to change their resource use but loosing insurance might result in loss of access to routine care.
The study shows that despite increasing insurance Medicaid expansions have not succeeded in reducing preventable hospitalizations or ED visits. However, the ACA has significantly benefited SUD patient by increasing treatment, and reducing their financial burden. Lastly, we show restricting Medicaid eligibility to FPL may only make the healthcare crisis in the US worse off instead of alleviating the situation.
|Advisor:||Martin, Bradley C.|
|Commitee:||Goudie, Anthony, Li, Chenghui, Morris, Michael, Painter, Jacob|
|School:||University of Arkansas for Medical Sciences|
|School Location:||United States -- Arkansas|
|Source:||DAI-B 79/10(E), Dissertation Abstracts International|
|Keywords:||Affordable care act, Arkansas, Medicaid expansion, Private option, Substance use|
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