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A new study has found that, although the Affordable Care Act (ACA) increased health insurance coverage in states that expanded their Medicaid program, the expansion did not translate into improved access to care or decreased preventable hospitalizations of patients with systemic lupus erythematosus (SLE).
“Our findings emphasize the importance of addressing systemic problems with American healthcare delivery at multiple levels,” wrote Elizabeth A. Brown, PhD, of the Medical University of South Carolina, Charleston, and her coauthors. The study was published in Arthritis Care & Research.
To examine the effects of the ACA’s Medicaid expansion on lupus patients when it was implemented Jan. 1, 2014, the researchers launched a retrospective, quasi‐experimental study using administrative data from eight states to compare eight quarterly time points in the 2 years prior to implementation against seven quarterly time points in the 2 years after implementation. Four states expanded Medicaid under the ACA – Arizona, Kentucky, New Jersey, and New York – and four of them did not – Florida, Georgia, South Carolina, and Wisconsin.
During the study period, there were 204,150 lupus hospitalizations across all eight states during the 15 quarters, 53% of which occurred in the four states that did not expand Medicaid. Although the investigators’ base model found that the probability of a preventable hospitalization did not increase over time (odds ratio, 1.004; 95% confidence interval, 0.996-1.013), the four expansion states had significantly higher odds of having preventable hospitalizations in the final adjusted model (OR, 1.302; 95% CI, 1.119-1.515).
Variables that contributed to higher odds of a preventable hospitalization included age: Lupus patients who were 55-64 years old had considerably higher odds for preventable lupus hospitalizations than did patients who were 20-34 years old (OR, 1.488; 95% CI, 1.415-1.564). In addition, those with a median household income under $42,000 had higher odds of hospitalization when compared with those making over $68,000 (OR, 1.138; 95% CI, 1.415-1.564), as did those on Medicaid compared with those on private insurance (OR, 1.298; 95% CI, 1.238-1.361).
The authors acknowledged their study’s limitations, including relying on potential coding errors within administrative data. In addition, they were unable to factor in Medicaid marketing, enrollment strategies, or other related actions undertaken in each of the eight states.
The study was partially supported by the South Carolina Clinical & Translational Research Institute via a National Center for Advancing Translational Sciences grant. The authors reported no conflicts of interest.
SOURCE: Brown EA et al. Arthritis Care Res. 2019 Sept 28. doi: 10.1002/acr.24080
A new study has found that, although the Affordable Care Act (ACA) increased health insurance coverage in states that expanded their Medicaid program, the expansion did not translate into improved access to care or decreased preventable hospitalizations of patients with systemic lupus erythematosus (SLE).
“Our findings emphasize the importance of addressing systemic problems with American healthcare delivery at multiple levels,” wrote Elizabeth A. Brown, PhD, of the Medical University of South Carolina, Charleston, and her coauthors. The study was published in Arthritis Care & Research.
To examine the effects of the ACA’s Medicaid expansion on lupus patients when it was implemented Jan. 1, 2014, the researchers launched a retrospective, quasi‐experimental study using administrative data from eight states to compare eight quarterly time points in the 2 years prior to implementation against seven quarterly time points in the 2 years after implementation. Four states expanded Medicaid under the ACA – Arizona, Kentucky, New Jersey, and New York – and four of them did not – Florida, Georgia, South Carolina, and Wisconsin.
During the study period, there were 204,150 lupus hospitalizations across all eight states during the 15 quarters, 53% of which occurred in the four states that did not expand Medicaid. Although the investigators’ base model found that the probability of a preventable hospitalization did not increase over time (odds ratio, 1.004; 95% confidence interval, 0.996-1.013), the four expansion states had significantly higher odds of having preventable hospitalizations in the final adjusted model (OR, 1.302; 95% CI, 1.119-1.515).
Variables that contributed to higher odds of a preventable hospitalization included age: Lupus patients who were 55-64 years old had considerably higher odds for preventable lupus hospitalizations than did patients who were 20-34 years old (OR, 1.488; 95% CI, 1.415-1.564). In addition, those with a median household income under $42,000 had higher odds of hospitalization when compared with those making over $68,000 (OR, 1.138; 95% CI, 1.415-1.564), as did those on Medicaid compared with those on private insurance (OR, 1.298; 95% CI, 1.238-1.361).
The authors acknowledged their study’s limitations, including relying on potential coding errors within administrative data. In addition, they were unable to factor in Medicaid marketing, enrollment strategies, or other related actions undertaken in each of the eight states.
The study was partially supported by the South Carolina Clinical & Translational Research Institute via a National Center for Advancing Translational Sciences grant. The authors reported no conflicts of interest.
SOURCE: Brown EA et al. Arthritis Care Res. 2019 Sept 28. doi: 10.1002/acr.24080
A new study has found that, although the Affordable Care Act (ACA) increased health insurance coverage in states that expanded their Medicaid program, the expansion did not translate into improved access to care or decreased preventable hospitalizations of patients with systemic lupus erythematosus (SLE).
“Our findings emphasize the importance of addressing systemic problems with American healthcare delivery at multiple levels,” wrote Elizabeth A. Brown, PhD, of the Medical University of South Carolina, Charleston, and her coauthors. The study was published in Arthritis Care & Research.
To examine the effects of the ACA’s Medicaid expansion on lupus patients when it was implemented Jan. 1, 2014, the researchers launched a retrospective, quasi‐experimental study using administrative data from eight states to compare eight quarterly time points in the 2 years prior to implementation against seven quarterly time points in the 2 years after implementation. Four states expanded Medicaid under the ACA – Arizona, Kentucky, New Jersey, and New York – and four of them did not – Florida, Georgia, South Carolina, and Wisconsin.
During the study period, there were 204,150 lupus hospitalizations across all eight states during the 15 quarters, 53% of which occurred in the four states that did not expand Medicaid. Although the investigators’ base model found that the probability of a preventable hospitalization did not increase over time (odds ratio, 1.004; 95% confidence interval, 0.996-1.013), the four expansion states had significantly higher odds of having preventable hospitalizations in the final adjusted model (OR, 1.302; 95% CI, 1.119-1.515).
Variables that contributed to higher odds of a preventable hospitalization included age: Lupus patients who were 55-64 years old had considerably higher odds for preventable lupus hospitalizations than did patients who were 20-34 years old (OR, 1.488; 95% CI, 1.415-1.564). In addition, those with a median household income under $42,000 had higher odds of hospitalization when compared with those making over $68,000 (OR, 1.138; 95% CI, 1.415-1.564), as did those on Medicaid compared with those on private insurance (OR, 1.298; 95% CI, 1.238-1.361).
The authors acknowledged their study’s limitations, including relying on potential coding errors within administrative data. In addition, they were unable to factor in Medicaid marketing, enrollment strategies, or other related actions undertaken in each of the eight states.
The study was partially supported by the South Carolina Clinical & Translational Research Institute via a National Center for Advancing Translational Sciences grant. The authors reported no conflicts of interest.
SOURCE: Brown EA et al. Arthritis Care Res. 2019 Sept 28. doi: 10.1002/acr.24080
FROM ARTHRITIS CARE & RESEARCH
Key clinical point: Expanded Medicaid coverage under the Affordable Care Act did not lead to decreased odds of preventable hospitalizations for lupus patients.
Major finding: After adjusted analysis, the four states with expanded Medicaid had significantly higher odds of having preventable hospitalizations than did the four that did not expand Medicaid (odds ratio, 1.302; 95% confidence interval, 1.119-1.515).
Study details: A retrospective, quasi‐experimental study using data from eight states, four that expanded Medicaid under the ACA and four that did not.
Disclosures: The study was partially supported by the South Carolina Clinical & Translational Research Institute via a National Center for Advancing Translational Sciences grant. The authors reported no conflicts of interest.
Source: Brown EA et al. Arthritis Care Res. 2019 Sept 28. doi: 10.1002/acr.24080.