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AHRQ Research Studies Date
Topics
- Access to Care (13)
- Ambulatory Care and Surgery (1)
- Behavioral Health (1)
- Cancer (2)
- Cancer: Cervical Cancer (1)
- Children's Health Insurance Program (CHIP) (1)
- Children/Adolescents (1)
- Community-Based Practice (1)
- Community Partnerships (1)
- Disparities (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (3)
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- Healthcare Utilization (4)
- (-) Health Insurance (29)
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- Low-Income (6)
- Medicaid (21)
- Medical Expenditure Panel Survey (MEPS) (4)
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- (-) Policy (29)
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- Racial and Ethnic Minorities (2)
- Risk (1)
- (-) Uninsured (29)
- Women (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 29 Research Studies DisplayedMeille G, Post B
AHRQ Author: Meille G
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
This AHRQ-authored paper describes the effect of the Affordable Care Act Medicaid expansion on hospital utilization, employment, and capital. The authors conducted a difference-in-differences analysis that compared changes to hospital demand and supply in Medicaid expansion and nonexpansion states. They used 2010-2016 data from the American Hospital Association and the Healthcare Cost Report Information System to quantify changes to hospital utilization and characterize how hospitals adjusted labor and capital inputs. Medicaid expansion was associated with increases in emergency department visits and other outpatient hospital visits. They found strong evidence that hospitals met increases in demand by hiring nursing staff and weaker evidence that they increased hiring of technicians and investments in equipment. They found no evidence that hospitals adjusted hiring of physicians, support staff, or investments in other capital inputs.
AHRQ-authored.
Citation: Meille G, Post B .
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
Med Care Res Rev 2023 Apr;80(2):165-74. doi: 10.1177/10775587221133165.
Keywords: Medicaid, Hospitals, Healthcare Utilization, Health Insurance, Policy, Access to Care, Uninsured
Berdahl TA, Moriya AS
AHRQ Author: Berdahl TA, Moriya AS
Insurance coverage for non-standard workers: experiences of temporary workers, freelancers, and part-time workers in the USA, 2010-2017.
This AHRQ-authored paper estimates insurance disparities across non-standard employment categories and determines how coverage disparities shifted following health reform in 2014. Data on working-age adults was analyzed from the 2010-2012 and 2015-2017 MEPS. Uninsurance decreased after health reform for all groups of nonstandard workers with a 10-14% point decline. Uninsurance remained high for all freelance workers at 30.8%, full-time temporary workers (25.1%) and part-time workers (17.9%) compared to full-time workers (11.9%). Lower uninsurance in a Medicaid expansion state was found for all categories of workers.
AHRQ-authored.
Citation: Berdahl TA, Moriya AS .
Insurance coverage for non-standard workers: experiences of temporary workers, freelancers, and part-time workers in the USA, 2010-2017.
J Gen Intern Med 2021 Jul;36(7):1997-2003. doi: 10.1007/s11606-021-06700-0..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Policy, Uninsured, Medicaid, Low-Income
Hatch B, Hoopes M, Darney BG
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Researchers assessed whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers. Data was collected from electronic health records in 14 states. The researchers found that among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and non-expansion states, although the overall rates remained low. They recommended continued support to overcome barriers to preventive care in this population.
AHRQ-funded; HS025155.
Citation: Hatch B, Hoopes M, Darney BG .
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Womens Health Issues 2021 Jan-Feb;31(1):9-16. doi: 10.1016/j.whi.2020.08.011..
Keywords: Cancer, Medicaid, Health Insurance, Uninsured, Access to Care, Policy, Cancer: Cervical Cancer, Prevention, Women, Healthcare Utilization
Hudson JL, Moriya AS
AHRQ Author: Hudson JL
The role of marketplace policy on welcome mat effects for children eligible for Medicaid or the Children's Health Insurance Program.
This study examined the role of marketplace policy on “welcome mat” effects for children eligible for Medicaid or the Children’s Health Insurance Program (CHIP). Data from the American Community Survey from 2013-2018 was used to estimate the relationship between Marketplace policy and increases in Medicaid/CHIP coverage among pre-ACA eligible children after the implementation of the Affordable Care Act (ACA). The sample included non-disabled citizen children ages 0-18 at 139-250% federal poverty level who were Medicaid/CHIP-eligible before and after implementation of the ACA. Marketplace policies and enrollment were compared in expansion states versus non-expansion states. Public coverage did increase more in states that empowered their Marketplace to enroll publicly-eligible applicants directly into Medicaid/CHIP. This was driven by enrollment policy, not by choice of state-based versus federal-based Marketplaces. Welcome mats were largest in expansion states and increases ranged from 9 to 13 percentage points in enrollment.
AHRQ-authored.
Citation: Hudson JL, Moriya AS .
The role of marketplace policy on welcome mat effects for children eligible for Medicaid or the Children's Health Insurance Program.
Inquiry 2020 Jan-Dec;57:46958020952920. doi: 10.1177/0046958020952920..
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Medicaid, Health Insurance, Policy, Uninsured, Access to Care
Zuvekas SH, McClellan CB, Ali MM
AHRQ Author: Zuvekas SH, McClellan CB
Medicaid expansion and health insurance coverage and treatment utilization among individuals with a mental health condition.
AHRQ-authored.
Citation: Zuvekas SH, McClellan CB, Ali MM .
Medicaid expansion and health insurance coverage and treatment utilization among individuals with a mental health condition.
J Ment Health Policy Econ 2020 Sep 1;23(3):151-82..
Keywords: Medical Expenditure Panel Survey (MEPS), Behavioral Health, Medicaid, Health Insurance, Access to Care, Healthcare Utilization, Policy, Uninsured
Tilhou AS, Huguet N, DeVoe J
The Affordable Care Act Medicaid Expansion positively impacted community health centers and their patients.
In this paper, the investigators summarized their results to-date as experts in investigating the impact of the Patient Protection and Affordable Care Act (ACA) Medicaid expansion on Community Health Centers (CHCs) and the patients they serve. They found the ACA Medicaid expansion increased access to care and preventive services, primarily in Medicaid expansion states. Rates of physical and mental health conditions rose substantially from pre- to post-ACA in expansion states, suggesting underdiagnosis pre-ACA.
AHRQ-funded; HS024270.
Citation: Tilhou AS, Huguet N, DeVoe J .
The Affordable Care Act Medicaid Expansion positively impacted community health centers and their patients.
J Gen Intern Med 2020 Apr;35(4):1292-95. doi: 10.1007/s11606-019-05571-w..
Keywords: Policy, Medicaid, Access to Care, Uninsured, Health Insurance
DeLia D, Yedidia MJ
The policy and practice legacy of the New Jersey Medicaid ACO Demonstration Project.
This paper examined the New Jersey Medicaid Accountable Care Organization (ACO) Demonstration and what was learned from the Demonstration. The Demonstration did not lead to a sustainable accountable care financing model as hoped for. Instead, the ACOs evolved into community health coalitions focused on a wide range of activities in partnership with state government, private health systems, community leaders, and MCOs. Policy parameters are currently being developed by the state to reposition the ACOs as regional partners to implement state-directed population health initiatives.
AHRQ-funded; HS023493.
Citation: DeLia D, Yedidia MJ .
The policy and practice legacy of the New Jersey Medicaid ACO Demonstration Project.
J Ambul Care Manage 2020 Jan/Mar;43(1):2-10. doi: 10.1097/jac.0000000000000308..
Keywords: Medicaid, Policy, Health Insurance, Uninsured
Nguyen KH, Trivedi AN
Asian American access to care in the Affordable Care Act era: findings from a population-based survey in California.
This study compared coverage and access to care between non-Hispanic White and Asian American adults after the ACA in California. The data was disaggregated into the five most populous ethnic subgroups (Chinese, Korean, Filipino, Vietnamese, and Japanese). The outcomes measured were 1) being uninsured, 2) having a usual source of care, 3) delaying necessary medical care, and 4) delaying necessary prescription medications. The sample included 19,201 non-Hispanic White and 3077 Asian American adults aged 18 to 64 in California. Koreans were significantly less likely to report a usual source of care relative to non-Hispanic whites while Chinese and Vietnamese adults were significantly less likely to delay necessary care.
AHRQ-funded; HS000011.
Citation: Nguyen KH, Trivedi AN .
Asian American access to care in the Affordable Care Act era: findings from a population-based survey in California.
J Gen Intern Med 2019 Nov;34(11):2660-68. doi: 10.1007/s11606-019-05328-5..
Keywords: Racial and Ethnic Minorities, Access to Care, Disparities, Health Insurance, Uninsured, Policy
Rasmussen PW, Kominski GF
Sources of success in California's individual marketplace under the Affordable Care Act.
When passed in 2010, the Affordable Care Act (ACA) became the greatest piece of health care reform in the United States since the creation of Medicare and Medicaid. In the 9 years since its passage, the law has ushered in a drastic decrease in the number of uninsured Americans and has encouraged delivery system innovation. Although, the ACA has not been uniformly embraced, California has been a leader. In this paper, the authors discuss sources of success in California's individual marketplace under the Affordable Care Act.
AHRQ-funded; HS000046.
Citation: Rasmussen PW, Kominski GF .
Sources of success in California's individual marketplace under the Affordable Care Act.
J Health Polit Policy Law 2019 Aug 1;44(4):679-706. doi: 10.1215/03616878-7530849..
Keywords: Policy, Health Insurance, Uninsured, Medicaid, Medicare
Pickens G, Karaca Z, Gibson TB
AHRQ Author: Karaca Z, Wong HS
Changes in hospital service demand, cost, and patient illness severity following health reform.
This study examined the effects of expanded Medicaid coverage and the health insurance exchange on the number of hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity. There was a significant drop in uninsured inpatient discharges and ED visits in states where Medicaid was expanded. For all by young females, uninsured inpatient discharge rates fell by 39% or greater. In nonexpansion states, the rates remained unchanged or increased slightly. Changes in all-payer and private insurance rates were not as dramatic, as was inpatient costs per discharge and all-payer inpatient costs.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Pickens G, Karaca Z, Gibson TB .
Changes in hospital service demand, cost, and patient illness severity following health reform.
Health Serv Res 2019 Aug;54(4):739-51. doi: 10.1111/1475-6773.13165..
Keywords: Access to Care, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Hospitals, Medicaid, Policy, Uninsured
Agarwal SD, Goldman AL, Sommers BD
Blue-collar workers had greatest insurance gains after ACA implementation.
The authors analyzed national survey data and found that workers in traditionally blue-collar industries experienced the largest gains in health insurance after implementation of the Affordable Care Act (ACA) in 2014. They found that, compared to other occupations, this group had lower employer-based coverage rates before the ACA. Most of the post-ACA coverage gains came from Medicaid and directly-purchased non-group insurance.
AHRQ-funded.
Citation: Agarwal SD, Goldman AL, Sommers BD .
Blue-collar workers had greatest insurance gains after ACA implementation.
Health Aff 2019 Jul;38(7):1140-44. doi: 10.1377/hlthaff.2018.05454..
Keywords: Health Insurance, Policy, Access to Care, Uninsured
Huguet N, Valenzuela S, Marino M
Following uninsured patients through Medicaid expansion: ambulatory care use and diagnosed conditions.
The authors assessed ambulatory care use and diagnosed health conditions among a cohort of community health center (CHC) patients uninsured before enactment of the Affordable Care Act (ACA) and followed them after enactment. They found that, post-ACA, 20.9% of patients remained uninsured, 15.0% gained Medicaid, 12.4% gained other insurance, and 51.7% did not have a visit. The authors concluded that a significant percentage of CHC patients remained uninsured; that many who remained uninsured had diagnosed health conditions; and that one-half continued to have three or more visits to CHCs, which continue to be essential providers for uninsured patients.
AHRQ-funded; HS024270.
Citation: Huguet N, Valenzuela S, Marino M .
Following uninsured patients through Medicaid expansion: ambulatory care use and diagnosed conditions.
Ann Fam Med 2019 Jul;17(4):336-44. doi: 10.1370/afm.2385..
Keywords: Access to Care, Ambulatory Care and Surgery, Community-Based Practice, Health Insurance, Healthcare Delivery, Medicaid, Policy, Uninsured
Seo V, Baggett TP, Thorndike AN
Access to care among Medicaid and uninsured patients in community health centers after the Affordable Care Act.
This study assessed differences in access to care for patients at Community Health Centers (CHCs) between those with continuous Medicaid coverage and those with gaps in insurance coverage, in order to examine the role of Medicaid coverage on care patterns for those with available safety net care. Data on adult patients with continuous Medicaid coverage and those with a period without insurance coverage in the last 12 months was gathered from the 2014 Health Center Patient Survey. Reported need for various types of care, prescription drugs, or referrals to care outside of the CHC, and reports of being delayed or unable to get needed care by insurance status were examined. Patients with insurance gaps were significantly more likely to report having difficulty obtaining medical care, prescription drugs, dental care, and completing outside referrals. The authors conclude that continuous Medicaid coverage appears to mitigate barriers to care for CHC patients when compared to those who have intermittent or no insurance coverage. Policies that increase disruptions in coverage could adversely impact access to care, even among those with available safety net care.
AHRQ-funding; HS025378.
Citation: Seo V, Baggett TP, Thorndike AN .
Access to care among Medicaid and uninsured patients in community health centers after the Affordable Care Act.
BMC Health Serv Res 2019 May 8;19(1):291. doi: 10.1186/s12913-019-4124-z..
Keywords: Access to Care, Health Insurance, Medicaid, Policy, Uninsured
Gordon SH, Sommers BD, Wilson IB
Risk factors for early disenrollment from Colorado's Affordable Care Act marketplace.
This study looked at risk factors for early disenrollment from Colorado’s Affordable Care Act marketplace. Researchers used all-payer claims data from individual market enrollees from 2014-2016. They discovered that nearly 25% Marketplace beneficiaries disenrolled midyear. The hazard rate of disenrollement was 30% lower in individuals with cost-sharing plans and 21% lower for those enrolled in gold plans compared to those enrolled in silver plans without cost-sharing subsidies. There was greater disenrollment in beneficiaries with greater hospital and emergency utilization before disenrollment. Also, young adults were 70% more likely to disenroll than older adults.
AHRQ-funded; HS025560.
Citation: Gordon SH, Sommers BD, Wilson IB .
Risk factors for early disenrollment from Colorado's Affordable Care Act marketplace.
Med Care 2019 Jan;57(1):49-53. doi: 10.1097/mlr.0000000000001020..
Keywords: Healthcare Costs, Health Insurance, Policy, Risk, Uninsured
Jacobs PD
AHRQ Author: Jacobs PD
Mandating health insurance coverage for high-income individuals.
In this study, the author describes the effect of the Affordable Care Act’s (ACA’s) individual mandate for health coverage by focusing on higher-income non-elderly adults and exploiting state differences in the rules governing premium setting and coverage issuance in the non-group market prior to 2014.
AHRQ-authored.
Citation: Jacobs PD .
Mandating health insurance coverage for high-income individuals.
National Tax Journal 2018 Dec;71(4):807-28. doi: 10.17310/ntj.2018.4.10..
Keywords: Health Insurance, Policy, Uninsured
Decker SL, Moriya AS, Soni A
AHRQ Author: AHRQ authors - Decker and Moriya
Coverage for self-employed and others without employer offers increased after 2014.
This study examined how the Affordable Care Act might have differentially affected insurance coverage for self-employed workers, wage earners with and without offers of employer-sponsored insurance, and people not employed.
AHRQ-authored.
Citation: Decker SL, Moriya AS, Soni A .
Coverage for self-employed and others without employer offers increased after 2014.
Health Aff 2018 Aug;37(8):1238-42. doi: 10.1377/hlthaff.2017.1663..
Keywords: Health Insurance, Policy, Uninsured
Vistnes JP, Cohen JW
AHRQ Author: Vistnes JP, Cohen JW
Duration of uninsured spells for nonelderly adults declined after 2014.
Using MEPS data, the authors found that nonelderly respondents in 2014-15, following implementation of ACA coverage provisions, experienced shorter periods of being uninsured than did respondents in 2012-13 and 2013-14, especially for people with preexisting health conditions.
AHRQ-authored.
Citation: Vistnes JP, Cohen JW .
Duration of uninsured spells for nonelderly adults declined after 2014.
Health Aff 2018 Jun;37(6):951-55. doi: 10.1377/hlthaff.2017.1638.
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Keywords: Health Insurance, Policy, Medical Expenditure Panel Survey (MEPS), Uninsured
Soni A, Sabik LM, Simon K
Changes in insurance coverage among cancer patients under the Affordable Care Act.
Uninsurance among patients with newly diagnosed cancer fell by one-third in the ACA’s first year. Coverage gains were significant across numerous common cancers, multiple demographic groups, and early-stage and late-stage disease. Large gains among Hispanic individuals were consistent with findings of other ACA studies and may indicate narrowing disparities.
AHRQ-funded; HS021291.
Citation: Soni A, Sabik LM, Simon K .
Changes in insurance coverage among cancer patients under the Affordable Care Act.
JAMA Oncol 2018 Jan;4(1):122-24. doi: 10.1001/jamaoncol.2017.3176.
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Keywords: Cancer, Health Insurance, Policy, Uninsured
Selden TM, Lipton BJ, Decker SL
AHRQ Author: Selden TM, Lipton BJ, Decker SL
Medicaid expansion and marketplace eligibility both increased coverage, with trade-offs in access, affordability.
The researchers found that as of 2015, adults with incomes of 100-138 percent of the federal poverty level had experienced large declines in uninsurance rates in both expansion and nonexpansion states. Adults in expansion and nonexpansion states also experienced similar increases in having a usual source of care and primary care visits, and similar reductions in delayed receipt of medical care due to cost.
AHRQ-authored.
Citation: Selden TM, Lipton BJ, Decker SL .
Medicaid expansion and marketplace eligibility both increased coverage, with trade-offs in access, affordability.
Health Aff 2017 Dec;36(12):2069-77. doi: 10.1377/hlthaff.2017.0830.
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Keywords: Access to Care, Health Insurance, Policy, Low-Income, Medicaid, Uninsured
Huguet N, Hoopes MJ, Angier H
Medicaid expansion produces long-term impact on insurance coverage rates in community health centers.
This study assesses changes in insurance status of patients visiting community health centers (CHCs) comparing states that expanded Medicaid to those that did not. Rates of uninsured visits decreased pre- to post- Affordable Care Act with greater drops in expansion (-57 percent) versus nonexpansion (-20 percent) states. Medicaid-insured visits increased 60 percent in expansion states while remaining unchanged in nonexpansion states.
AHRQ-funded; HS024270.
Citation: Huguet N, Hoopes MJ, Angier H .
Medicaid expansion produces long-term impact on insurance coverage rates in community health centers.
J Prim Care Community Health 2017 Oct;8(4):206-12. doi: 10.1177/2150131917709403.
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Keywords: Community Partnerships, Health Insurance, Policy, Medicaid, Uninsured
Sommers BD, Maylone B, Blendon RJ
Three-year impacts of the Affordable Care Act: improved medical care and health among low-income adults.
Using survey data collected from low-income adults through the end of 2016 in three states: Kentucky, which expanded Medicaid; Arkansas, which expanded private insurance to low-income adults using the federal Marketplace; and Texas, which did not expand coverage, researchers found that by the end of 2016 the uninsurance rate in the two expansion states had dropped by more than 20 percentage points relative to the nonexpansion state.
AHRQ-funded; HS021291.
Citation: Sommers BD, Maylone B, Blendon RJ .
Three-year impacts of the Affordable Care Act: improved medical care and health among low-income adults.
Health Aff 2017 Jun;36(6):1119-28. doi: 10.1377/hlthaff.2017.0293.
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Keywords: Policy, Low-Income, Access to Care, Health Insurance, Uninsured
Decker SL, Lipton BJ, Sommers BD
AHRQ Author: Decker SL, Lipton BJ
Medicaid expansion coverage effects grew in 2015 with continued improvements in coverage quality.
The researchers used detailed federal survey data through 2015 to analyze recent changes in coverage for low-income adults after the expansion associated with the Affordable Care Act's (ACA's) Medicaid expansion in 2014. They found that the uninsurance rate fell in both expansion and nonexpansion states but that it fell significantly more in expansion states.
AHRQ-authored; AHRQ-funded; HS021291.
Citation: Decker SL, Lipton BJ, Sommers BD .
Medicaid expansion coverage effects grew in 2015 with continued improvements in coverage quality.
Health Aff 2017 May;36(5):819-25. doi: 10.1377/hlthaff.2016.1462.
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Keywords: Medicaid, Low-Income, Health Insurance, Uninsured, Policy
Decker SL, Lipton BJ
AHRQ Author: Decker SL, Lipton BJ
Most newly insured people in 2014 were long-term uninsured.
This study found that in 2014-after the implementation of most of the Affordable Care Act provisions, including Medicaid expansions in some states and subsidies to purchase Marketplace coverage in all states-adults who had been uninsured for more than three years represented a larger share of the newly insured, compared to adults who had been insured for shorter periods of time.
AHRQ-authored.
Citation: Decker SL, Lipton BJ .
Most newly insured people in 2014 were long-term uninsured.
Health Aff 2017 Jan;36(1):16-20. doi: 10.1377/hlthaff.2016.0984.
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Keywords: Health Insurance, Uninsured, Medicaid, Policy
Vistnes JP, Cohen JW
AHRQ Author: Vistnes JP, Cohen JW
Gaining coverage in 2014: new estimates of marketplace and Medicaid transitions.
The researchers used data from the Medical Expenditure Panel Survey-Household Component to examine coverage transitions for nonelderly US adults. They found that 71.5 percent of Marketplace enrollees in 2014 had some period of uninsurance before enrollment. In Medicaid expansion states, 17.4 percent of adults who were uninsured throughout 2013 gained Medicaid coverage in 2014, compared with only 5.6 percent in those states between 2012 and 2013.
AHRQ-authored.
Citation: Vistnes JP, Cohen JW .
Gaining coverage in 2014: new estimates of marketplace and Medicaid transitions.
Health Aff 2016 Oct 1;35(10):1825-29. doi: 10.1377/hlthaff.2016.0500.
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Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Medicaid, Uninsured, Policy
Sommers BD, Gourevitch R, Maylone B
Insurance churning rates for low-income adults under health reform: lower than expected but still harmful for many.
The researchers explored the frequency and implications of changes in insurance coverage over time (i.e., "churning,")through surveying low-income adults in Kentucky, which used a traditional expansion of Medicaid; Arkansas, which chose a "private option" expansion that enrolled beneficiaries in private Marketplace plans; and Texas, which opted not to expand. They found that churning was associated with disruptions in physician care and medication adherence, and increased emergency department use.
AHRQ-funded; HS021291.
Citation: Sommers BD, Gourevitch R, Maylone B .
Insurance churning rates for low-income adults under health reform: lower than expected but still harmful for many.
Health Aff 2016 Oct;35(10):1816-24. doi: 10.1377/hlthaff.2016.0455.
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Keywords: Medicaid, Uninsured, Policy, Health Insurance