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1 Although Medicaid expansion has been shown to be associated with increased access to health services, increased quality of medical care delivered, and reduced mortality, 2 - 5 little is known about its association with individuals’ use of long-term care (LTC), including use of formal home health or nursing home care. The Patient Protection and Affordable Care Act (ACA) increased health insurance coverage for 20 million individuals in the US, with much of this gain occurring through expansion of the state-administered Medicaid program. The ACA-funded Medicaid expansion was associated with an increase of 4.4 percentage points (95% CI, 2.8-6.1 percentage points) in the probability of any long-term care use among low-income, middle-aged adults, with increases in home health use (3.8 percentage points 95% CI, 2.0-5.6 percentage points) and in any nursing home use (2.1 percentage points 95% CI, 0.9-3.3 percentage points).Ĭonclusions and Relevance In this study, ACA-funded Medicaid expansion was associated with an increase in any long-term care use among newly eligible low-income, middle-aged adults, suggesting that the population covered by the Medicaid expansion may have had unmet long-term care needs before expansion. Before the ACA-funded Medicaid expansion, 0.4% (95% CI, −0.3% to 1.1%) in expansion states and 1.0% (95% CI, −0.1% to 2.2%) in nonexpansion states used nursing homes, and 1.9% (95% CI, 0.4%-3.4%) in expansion states and 7.1% (95% CI, 4.7%-9.5%) in nonexpansion states used any formal home care. Results Among the 891 individuals likely eligible for expanded Medicaid, the mean (SD) age was 55.2 (3.1) years 534 (53.4%) were women, 482 (49.5%) were married, and 661 (45.9%) were White non-Hispanic.
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All estimates are weighted to account for the Health and Retirement Study sampling design. Main Outcomes and Measures Any home health care use or any nursing home use in 2014 or 2016.
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Data were analyzed from January 15, 2018, to December 31, 2019.Įxposures Residence in a state with Medicaid expansion in 2014. Low-income adults who were covered by Medicare and were ineligible for expanded Medicaid were also included in the analysis. Long-term care use from 2008 to 2012 was compared with use from 2014 to 2016 among low-income adults aged 50 to 64 years without Medicare coverage residing in states in which Medicaid coverage expanded in 2014 and those living in states without expansion. Objective To examine the association of Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) with long-term care use among newly eligible low-income adults and among older adults whose eligibility did not change.ĭesign, Setting, and Participants This difference-in-difference cohort study used data from the Health and Retirement Study, a nationally representative longitudinal survey of persons 50 years or older. Importance Medicaid expansion is associated with increased access to health services, increased quality of medical care delivered, and reduced mortality, but little is known about its association with use of long-term care.
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