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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 376 Research Studies Displayed
Cha P, Escarce JJ
The Affordable Care Act Medicaid expansion: a difference-in-differences study of spillover participation in SNAP.
Medicaid expansion through the Affordable Care Act increased access to insurance coverage to adults under 138% of the federal poverty level and connected individuals to SNAP (the Supplemental Nutrition Assistance Food Program – formerly the Food Stamp Program). The purpose of this study was to estimate the effect of Medicaid expansion on SNAP participation among 414,000 individuals across the U.S. The study found that there was a 2.9% increase in SNAP participation produced by Medicaid expansion among individuals living under 138% of the federal poverty level. In subgroup analyses the researchers discovered a 5% increase in households without children below 75% of the federal poverty level, and an increase in SNAP households with zero dollars in income. The study concluded that the impact of the Medicaid expansion on access to SNAP participation was the greatest in very-low-income individuals, and that the impact of Medicaid expansion reaches beyond healthcare by increasing access to other supports like food which is a social determinant of health.
AHRQ-funded; HS000046.
Citation:
Cha P, Escarce JJ .
The Affordable Care Act Medicaid expansion: a difference-in-differences study of spillover participation in SNAP.
PLoS One 2022 May 4;17(5):e0267244. doi: 10.1371/journal.pone.0267244..
Keywords:
Medicaid, Nutrition, Low-Income, Health Insurance
Jacobs PD, Abdus S
Changes in preventive service use by race and ethnicity after Medicare eligibility in the United States.
Researchers examined whether widespread eligibility for Medicare at age 65 narrows disparate preventive service use by race and ethnicity. Using MEPS data and examining six preventive services, they found that, for non-Hispanic Black adults, preventive service use increased after age 65. Further, for all four preventive health measures that were lower for Hispanic adults compared with non-Hispanic White adults prior to age 65, service use was indistinguishable between these groups after reaching the Medicare eligibility age. They concluded that Medicare eligibility appeared to reduce most racial and ethnic disparities in preventive service use.
AHRQ-authored.
Citation:
Jacobs PD, Abdus S .
Changes in preventive service use by race and ethnicity after Medicare eligibility in the United States.
Prev Med 2022 Apr;157:106996. doi: 10.1016/j.ypmed.2022.106996..
Keywords:
Medical Expenditure Panel Survey (MEPS), Racial / Ethnic Minorities, Medicare, Prevention, Access to Care, Disparities, Health Insurance
Dorilas E, Hill SC, Pesko MF
Tobacco surcharges associated with reduced ACA marketplace enrollment.
Researchers used 2014-19 administrative data on enrollees in the federally facilitated Affordable Care Act Marketplace, HealthCare.gov, to examine the relationships among surcharge rates, total Marketplace enrollment, and enrollment by tobacco users. They found that the tobacco surcharge rate was associated with lower total enrollment as well as a reduced share of total enrollees who reported any tobacco use. Further, tobacco surcharges have a significantly larger effect on tobacco users' share of enrollment in rural areas than in urban areas, which may contribute to urban-rural health disparities.
AHRQ-authored.
Citation:
Dorilas E, Hill SC, Pesko MF .
Tobacco surcharges associated with reduced ACA marketplace enrollment.
Health Aff 2022 Mar;41(3):398-405. doi: 10.1377/hlthaff.2021.01313..
Keywords:
Tobacco Use, Policy, Health Insurance
Cliff BQ
Do high-deductible health plans affect price paid for childbirth?
The purpose of this study was to test whether out-of-pocket costs and negotiated hospital prices for childbirth change after enrollment in high-deductible health plans (HDHPs) and whether price effects differ in markets with more hospitals. Administrative medical claims data from three large commercial insurers with plans in all U.S. states was provided by the Health Care Cost Institute. Findings showed that prices for childbirth in markets with more hospitals decreased after HDHP switch due to lower hospital prices for HDHPs relative to prices at those same hospitals for non-HDHPs.
AHRQ-funded; HS025614.
Citation:
Cliff BQ .
Do high-deductible health plans affect price paid for childbirth?
Health Serv Res 2022 Feb;57(1):27-36. doi: 10.1111/1475-6773.13702..
Keywords:
Labor and Delivery, Health Insurance, Healthcare Costs, Women
Decker SL, Abdus S, Lipton BJ
Eligibility for and enrollment in Medicaid among nonelderly adults after implementation of the Affordable Care Act.
The authors used simulation modeling to examine Medicaid eligibility and participation during 2014 to 2017. They found that more than one in five adults were Medicaid-eligible in expansion states, while about one in 30 adults were Medicaid-eligible in non-expansion states. Further, while eligibility rates differed substantially by expansion status, participation rates among Medicaid-eligible adults were similar in both sets of states, indicating that differences in eligibility, rather than in participation rates, explained differences in enrollment between expansion and non-expansion states during the study period.
AHRQ-authored.
Citation:
Decker SL, Abdus S, Lipton BJ .
Eligibility for and enrollment in Medicaid among nonelderly adults after implementation of the Affordable Care Act.
Med Care Res Rev 2022 Feb;79(1):125-32. doi: 10.1177/1077558721996851..
Keywords:
Medical Expenditure Panel Survey (MEPS), Medicaid, Health Insurance
Dennett JM, Baicker K
Medicaid, health, and the moderating role of neighborhood characteristics.
The purpose of this study was to evaluate whether the characteristics of different neighborhoods have an impact on the interaction between local environment and the effect of health insurance on health. The researchers utilized existing data from the Oregon Health Insurance Experiment and combined it with new, expanded data on neighborhood characteristics to assess whether those characteristics impacted the relationship between getting health insurance and health outcomes. The study found that the multiple domains of neighborhood characteristics did not affect the correlation between insurance and health outcomes, and concluded that Medicaid expansions do not differ greatly in effectiveness across neighborhoods.
AHRQ-funded; HS000055.
Citation:
Dennett JM, Baicker K .
Medicaid, health, and the moderating role of neighborhood characteristics.
J Urban Health 2022 Feb;99(1):116-33. doi: 10.1007/s11524-021-00579-2..
Keywords:
Medicaid, Social Determinants of Health, Health Insurance
Sinaiko AD, Hayes M, Kingsdale J
Understanding consumer experiences and insurance outcomes following plan disenrollment in the nongroup insurance market.
Disenrollment from health plans purchased on Affordable Care Act (ACA) Marketplaces is frequent; little is known whether disenrollment from off-Marketplace plans is as common or about the experiences and consequences of disenrollment. Using longitudinal administrative data on 2017-2018 nongroup plan enrollment linked with survey data, the investigators analyzed plan disenrollment in one regional insurance carrier servicing three states.
AHRQ-funded; HS024700.
Citation:
Sinaiko AD, Hayes M, Kingsdale J .
Understanding consumer experiences and insurance outcomes following plan disenrollment in the nongroup insurance market.
Med Care Res Rev 2022 Feb;79(1):36-45. doi: 10.1177/1077558721998910..
Keywords:
Health Insurance
Porteny T, Ponce N, Sommers BD
Immigrants and the Affordable Care Act: changes in coverage and access to care by documentation status.
This study used data from the California Health Interview Survey (2003-2016) to compare changes in health coverage and access to care among immigrants in California before and after the Affordable Care Act (ACA). The authors found that the ACA has led to major gains in coverage for lawful permanent residents in California, but unauthorized immigrants experienced only modest increases in coverage. This result widened the disparity in uninsured rates for unauthorized immigrants relative to citizens considerably since 2014.
AHRQ-funded; HS000055.
Citation:
Porteny T, Ponce N, Sommers BD .
Immigrants and the Affordable Care Act: changes in coverage and access to care by documentation status.
J Immigr Minor Health 2022 Feb;24(1):86-94. doi: 10.1007/s10903-020-01124-0..
Keywords:
Access to Care, Health Insurance, Uninsured, Vulnerable Populations
Cham S, Landrum MB, Keating NL
Use of germline BRCA testing in patients with ovarian cancer and commercial insurance.
The authors examined commercially insured populations to identify patient-, physician-, and practice-level characteristics associated with ovarian cancer testing rates. They found that only 33.9% of patients with commercial insurance were tested during the time period studied. Medical and gynecologic oncologists had similar rates of testing, while other physicians tested less often. Although independent practices often lack access to genetic counselors, women in this study had insurance coverage for in-person and telephonic counseling.
AHRQ-funded; HS024072.
Citation:
Cham S, Landrum MB, Keating NL .
Use of germline BRCA testing in patients with ovarian cancer and commercial insurance.
JAMA Netw Open 2022 Jan 4;5(1):e2142703. doi: 10.1001/jamanetworkopen.2021.42703..
Keywords:
Cancer: Ovarian Cancer, Cancer, Screening, Genetics, Health Insurance, Women
Chang L, Rees CA, Michelson KA
Association of socioeconomic characteristics with where children receive emergency care.
This study’s objective was to characterize national associations of neighborhood income and insurance type for children with the characteristics of emergency departments (EDs) from which they receive care. The authors conducted a cross-sectional study of ED visits by children from 2014 to 2017 using the Nationwide Emergency Department Sample. Emergency department characteristics were characterized by pediatric volume category. There was a total of 107.6 million ED visits from 2014 to 2017. Children outside of the wealthiest neighborhood income quartile had lower proportions of visits to high-volume pediatric EDs and greater proportions of visits to low-volume pediatric EDs than children in the wealthiest quartile. Publicly insured children were modestly more likely to visit higher-volume pediatric EDs than privately insurance and uninsured children. This association appears to be principally driven by urban-rural differences in access to pediatric emergency care.
AHRQ-funded; HS026503.
Citation:
Chang L, Rees CA, Michelson KA .
Association of socioeconomic characteristics with where children receive emergency care.
Pediatr Emerg Care 2022 Jan;38(1):e264-e67. doi: 10.1097/pec.0000000000002244..
Keywords:
Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Health Insurance, Uninsured, Low-Income
Admon LK, Dalton VK, Kolenic GE
Comparison of delivery-related, early and late postpartum severe maternal morbidity among individuals with commercial insurance in the US, 2016 to 2017.
This study analyzed data from 2016 to 2017 on delivery-related, early, and late postpartum severe maternal morbidity (SMM) among individuals with commercial insurance by race and ethnicity and perinatal mood and anxiety disorder (PMAD) status. This cross-sectional study of deidentified claims data from the Optum Clinformatics Data Mart evaluated rates of SMM during 3 pregnancy periods among individuals aged 15 to 44 years. The study sample comprised of 100,982 individuals with a mean age of 31.6 years. SMM rates were compared for pregnancies with and without complications, with blood transfusions being the number one indicator for pregnancy and postpartum periods with SMM. Rates of SMM with and without blood transfusion varied by race and ethnicity and PMAD status. Higher rates of SMM were identified among Black individuals compared with White individuals for the pregnancy, early postpartum, and late postpartum periods, respectively. Higher rates of blood transfusion were also identified in each of the 3 periods among individuals with PMADs compared to individuals without PMADs.
AHRQ-funded; HS027640.
Citation:
Admon LK, Dalton VK, Kolenic GE .
Comparison of delivery-related, early and late postpartum severe maternal morbidity among individuals with commercial insurance in the US, 2016 to 2017.
JAMA Netw Open 2021 Dec;4(12):e2137716. doi: 10.1001/jamanetworkopen.2021.37716..
Keywords:
Labor and Delivery, Pregnancy, Maternal Care, Pregnancy, Health Insurance, Racial / Ethnic Minorities, Anxiety
Neprash HT, Zink A, Sheridan B
The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care.
AHRQ-funded; HS024455.
Citation:
Neprash HT, Zink A, Sheridan B .
The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care.
J Health Econ 2021 Dec;80:102541. doi: 10.1016/j.jhealeco.2021.102541..
Keywords:
Medicare, Healthcare Utilization, Primary Care, Workforce, Health Insurance
McInerney M, Mellor JM, Sabik LM. M, Mellor JM, Sabik LM
Welcome mats and on-ramps for older adults: the impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid.
The authors examined whether Medicaid participation by low-income adults age 65 and up increased as a result of Medicaid expansions to working-age adults under the Affordable Care Act (ACA). Using American Community Survey data and state variation in ACA Medicaid expansions, they found that Medicaid expansions to working-age adults increased Medicaid participation among low-income older adults by 4.4 percent. They also found evidence of an “on-ramp” effect, which is an important mechanism behind welcome mat effects among some older adults.
AHRQ-funded; HS025422.
Citation:
McInerney M, Mellor JM, Sabik LM. M, Mellor JM, Sabik LM .
Welcome mats and on-ramps for older adults: the impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid.
J Policy Anal Manage 2021 Win;40(1):12-41. doi: 10.1002/pam.22259..
Keywords:
Elderly, Medicaid, Medicare, Low-Income, Health Insurance, Policy
Rasmussen PW, Anderson D
When all that glitters is gold: dominated plan choice on Covered California for the 2018 plan year.
The Affordable Care Act (ACA) individual health insurance marketplaces rely on purchasers to make informed choices to impose price and quality discipline on a complex array of insurance products. A sudden and minimally expected policy shock in the fall of 2017-the termination of direct federal payment for cost-sharing reduction (CSR) subsidies-led to a substantial change in the relative prices of silver and gold plans on the Covered California insurance marketplace. In this study, the investigators used the Covered California enrollment and product files from 2014 to 2018 in a retrospective data analysis of plan choice.
AHRQ-funded; HS026835.
Citation:
Rasmussen PW, Anderson D .
When all that glitters is gold: dominated plan choice on Covered California for the 2018 plan year.
Milbank Q 2021 Dec;99(4):1059-87. doi: 10.1111/1468-0009.12518..
Keywords:
Health Insurance
Jacobs PD, Hill SC
ACA marketplaces became less affordable over time for many middle-class families, especially the near-elderly.
This study calculated Marketplace premiums as a percentage of family income among middle-class families with incomes of 401-600% of poverty. The ACA premiums have been increasing since inception, with half of this population paying at least 7.7% of their income for the lowest-cost bronze plan, increasing to 11.3% in 2019. By 2019 half of the near elderly ages 55-64 would have paid at least 18.9% of their income for the lowest-cost bronze plan in their area. Results suggest that after the American Rescue Plan Act which temporarily expanded tax credit eligibility for 2021 and 2022 runs out, families will again face substantial financial burdens.
AHRQ-authored.
Citation:
Jacobs PD, Hill SC .
ACA marketplaces became less affordable over time for many middle-class families, especially the near-elderly.
Health Aff 2021 Nov;40(11):1713-21. doi: 10.1377/hlthaff.2021.00945..
Keywords:
Health Insurance, Healthcare Costs
Jiang DH, Mundell BF, Shah ND
Impact of high deductible health plans on diabetes care quality and outcomes: systematic review.
The authors sought to provide a systematic literature review of the impact of high deductible health plans (HDHPs) on the utilizations of services required for optimal management of diabetes and subsequent health outcomes. They found that, although HDHPs reduce some health care utilization and costs, they appear to do so at the expense of limiting high-value care and medication adherence.
AHRQ-funded; HS025517; HS024075; HS025164; HS025402.
Citation:
Jiang DH, Mundell BF, Shah ND .
Impact of high deductible health plans on diabetes care quality and outcomes: systematic review.
Endocr Pract 2021 Nov;27(11):1156-64. doi: 10.1016/j.eprac.2021.07.001..
Keywords:
Health Insurance, Diabetes, Chronic Conditions, Outcomes, Quality of Care, Patient-Centered Outcomes Research
Lipton BJ, Finlayson TL
The association between Medicaid adult dental coverage and children's oral health.
This study examined the association of Medicaid adult dental coverage and children’s oral health as Medicaid-eligible children are more likely to experience tooth decay than children in higher-income families. Data from the 1996-2016 National Health and Nutrition Examination Survey and the 2003, 2007, and 2011-12 waves of the National Survey of Children’s Health was used. Adult dental coverage was associated with a 5-percentage-point reduction in the prevalence of untreated caries among children after Medicaid-enrolled adults had access to dental coverage for at least one year. Children under twelve years of age were the most affected.
AHRQ-authored.
Citation:
Lipton BJ, Finlayson TL .
The association between Medicaid adult dental coverage and children's oral health.
Health Aff 2021 Nov;40(11):1731-39. doi: 10.1377/hlthaff.2021.01135..
Keywords:
Children/Adolescents, Dental and Oral Health, Medicaid, Health Insurance, Access to Care
Aouad M, Brown TT, Whaley CM
Understanding the distributional impacts of health insurance reform: evidence from a consumer cost-sharing program.
Investigators examined the heterogeneous effects of reference pricing, a health insurance reform introduced by the California Public Employees' Retirement System (CalPERS), on the distribution of spending by patients and insurers. Using the changes-in-changes approach to estimate the quantile treatment effects (QTE) of the program across different medical procedures, they found that the QTE vary across the patient spending distributions, with a range of positive and negative estimates of the QTE, depending on the medical procedure considered.
AHRQ-funded; HS022098.
Citation:
Aouad M, Brown TT, Whaley CM .
Understanding the distributional impacts of health insurance reform: evidence from a consumer cost-sharing program.
Health Econ 2021 Nov;30(11):2780-93. doi: 10.1002/hec.4410..
Keywords:
Health Insurance, Healthcare Costs
Abdus S
Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans.
This study examines financial burdens of out-of-pocket prescription drug expenditures across different levels of deductibles, focusing on low-income adults with multiple, prevalent chronic conditions. The results of this study suggest that for low-income adults with multiple chronic conditions who are enrolled in employer-sponsored high-deductible plans, out-of-pocket prescription drug costs may still result in significant financial hardships. The key takeaway point of this paper for general internists is that for patients with chronic conditions, out-of-pocket costs of prescription drugs could be excessively burdensome if they are enrolled in high-deductible plans.
AHRQ-authored.
Citation:
Abdus S .
Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans.
J Gen Intern Med 2021 Sep;36(9):2903-05. doi: 10.1007/s11606-020-06226-x..
Keywords:
Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Medication
Hero JO, Sinaiko AD, Peltz A
In New England, partisan differences In ACA marketplace participation and potential financial harm.
This study examined how political orientation was associated with decisions to use the Affordable Care Act Marketplaces to enroll in nongroup health insurance plans and whether it was also associated with adverse financial consequences. Using data from a large insurer in New England, findings showed that Republican enrollees were less likely than Democratic enrollees of comparable subsidy eligibility to enroll through the Marketplaces and receive subsidies. Among income-eligible enrollees, Republican subscribers received $66 per month less in premium subsidies than Democratic subscribers. However, results suggested that party effects on decision making may inversely relate to the magnitude of the financial consequence.
AHRQ-funded; HS024700.
Citation:
Hero JO, Sinaiko AD, Peltz A .
In New England, partisan differences In ACA marketplace participation and potential financial harm.
Health Aff 2021 Sep;40(9):1420-29. doi: 10.1377/hlthaff.2021.00624..
Keywords:
Health Insurance, Healthcare Costs
Markovitz AA, Ayanian JZ, Warrier A
Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements.
Using national data for 2008-18, investigators found that double bonuses were not associated with either improvements in plan quality or increased Medicare Advantage enrollment. Additionally, double bonuses increased payments to plans to care for Black beneficiaries by $60 per year, compared with $91 for White beneficiaries. These findings suggest that double bonuses not only fail to improve quality and enrollment but also foster a racially inequitable distribution of Medicare funds that disfavors Black beneficiaries. This study supports eliminating double bonuses, thereby saving Medicare an estimated $1.8 billion per year.
AHRQ-funded; HS000053.
Citation:
Markovitz AA, Ayanian JZ, Warrier A .
Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements.
Health Aff 2021 Sep;40(9):1411-19. doi: 10.1377/hlthaff.2021.00349..
Keywords:
Medicare, Health Insurance, Payment, Quality Improvement, Quality of Care, Disparities, Racial / Ethnic Minorities
Chua KP, Linder JA
Prevalence of inappropriate antibiotic prescribing by antibiotic among privately and publicly insured non-elderly US patients, 2018.
The authors used 2018 commercial and Medicaid claims to assess inappropriate prescribing of antibiotics. In their analysis, 22% of antibiotic claims were inappropriate. Azithromycin had an outsized role in inappropriate prescribing. They concluded that broad-based stewardship initiatives remain important given widespread inappropriate prescribing of all antibiotics.
AHRQ-funded; HS024930; HS026506; 2332015000201.
Citation:
Chua KP, Linder JA .
Prevalence of inappropriate antibiotic prescribing by antibiotic among privately and publicly insured non-elderly US patients, 2018.
J Gen Intern Med 2021 Sep;36(9):2861-64. doi: 10.1007/s11606-020-06189-z..
Keywords:
Antibiotics, Antimicrobial Stewardship, Medication, Medicaid, Health Insurance
Roberts ET, Glynn A, Donohue JM
The relationship between take-up of prescription drug subsidies and Medicaid among low-income Medicare beneficiaries.
In this study, the investigators examined take-up of the Low-Income Subsidy (LIS) and Medicaid among Medicare beneficiaries who qualified for both programs. They went beyond prior analyses that reported average enrollment by program by 1.) examining whether LIS take-up mirrored Medicaid enrollment at income levels where individuals qualified for limited Medicaid benefits that had low take-up rates and 2.) highlighting opportunities for policy reforms to increase participation in both programs.
AHRQ-funded; HS026727.
Citation:
Roberts ET, Glynn A, Donohue JM .
The relationship between take-up of prescription drug subsidies and Medicaid among low-income Medicare beneficiaries.
J Gen Intern Med 2021 Sep;36(9):2873-76. doi: 10.1007/s11606-020-06241-y..
Keywords:
Medicaid, Medicare, Medication, Low-Income, Health Insurance
Schechter SB, Pantell MS, Parikh K
Impact of a national quality collaborative on pediatric asthma care quality by insurance status.
The objective of this study was to assess whether disparities in asthma care and outcomes based on insurance type existed before a national quality improvement (QI) collaborative, and to determine the effects of the collaborative on these disparities. The investigators concluded that at baseline, children with public insurance had higher asthma health care utilization than those with private insurance, despite receiving more evidence-based care.
AHRQ-funded; HS026383; HS024554; HS024592.
Citation:
Schechter SB, Pantell MS, Parikh K .
Impact of a national quality collaborative on pediatric asthma care quality by insurance status.
Acad Pediatr 2021 Aug;21(6):1018-24. doi: 10.1016/j.acap.2021.02.009..
Keywords:
Children/Adolescents, Asthma, Chronic Conditions, Disparities, Quality Improvement, Quality of Care, Health Insurance
Moloci NM, Si Y, Norton EC
Predicting losses from Medicare Shared Savings Program departures.
Researchers conducted an observational study to understand how accountable care organization (ACO) exit could affect Shared Savings Program (SSP) financial performance. They found that nearly 80% of ACOs were still active at the end of 2016. Among the subset that faced contract renewal in 2019, 40% were known to have exited the SSP. By 2022, ACOs that exited in 2019 could cost the SSP $186.9 million in lost savings. If the exit rate observed in 2019 continues, the SSP could suffer $396.8 million in lost savings by 2022.
AHRQ-funded; HS024525; HS024728.
Citation:
Moloci NM, Si Y, Norton EC .
Predicting losses from Medicare Shared Savings Program departures.
J Gen Intern Med 2021 Aug;36(8):2490-91. doi: 10.1007/s11606-020-06424-7..
Keywords:
Medicare, Health Insurance, Healthcare Costs
