The impact of the Affordable Care Act's medicaid expansion on patients admitted for burns: An analysis of national data. Issue 6 (September 2022)

• Record Type: Journal Article
• Authors: Dalton, Michael K.; Riviello, Robert; Kubasiak, John C.; Sokas, Claire M.; Osman, Samia Y.; Jin, Ginger; Nitzschke, Stephanie L.; Ortega, Gezzer
• Is Part Of: Burns. Volume 48:Issue 6(2022)
• Page Start: 1340
• Page End: 1346
• Publication Date: 2022-09
• Subjects: ACA Patient Protection and Affordable Care Act -- TBSA Total Body Surface Area -- HCUP Healthcare Cost and Utilization Project -- NIS National Inpatient Sample; Burns -- Medicaid -- Affordable Care Act -- Medicaid expansion; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2021.10.018
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: Burn patients saw significantly higher rates of Medicaid coverage after Medicaid Expansion. Those living in the Northeast and West regions had the largest increases. No changes seen in discharge disposition or hospital length of stay. Abstract: Introduction: The first states began implementing the Medicaid expansion provisions of the Patient Protection and Affordable Care Act (ACA) in 2014. Studies have yet to address its impact on burn patients. Methods: Burn patients in geographic regions that expanded Medicaid coverage were compared to patients in regions that did not expand Medicaid before and after implementation of the ACA using bivariate statistics and a difference-in-differences model. A multivariable logistic regression was used to identify factors associated with having Medicaid insurance. The primary outcome of this study was the rate of Medicaid insurance. Results: Of 25, 331 discharges, we found greater increases in Medicaid coverage after the ACA in the Medicaid expander regions (23.4–40.2%) compared to the non-expander regions (18.5–20.1%). The difference-in-differences estimate between the expander and non-expander regions was 0.15 (95% CI: 0.11–0.18, p < 0.001). Patients admitted in expander regions were more likely to be insured by Medicaid (OR 1.57 [95%CI 1.21–2.05]), as were patients of Black race (OR 1.25 [95%CI 1.19–1.32), Hispanic ethnicity (OR 1.29 [95%CI 1.14–1.46]), and female sex (OR 1.59 [95%CI 1.11–2.27]). We also found a significant interaction between time period (pre-ACA/post-ACA) and expander region location (OR 2.10 [95%CI 1.67–2.62]). Conclusions: The Medicaid expansion provision of the ACA led to increased Medicaid coverage among burn patients which was significantly higher in areas with widespread implementation of the expansion.