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Showing content from https://pubmed.ncbi.nlm.nih.gov/29181792 below:

Medicaid Expansion, Mental Health, and Access to Care among Childless Adults with and without Chronic Conditions

Comparative Study

Affiliations

• ¹ Division of General Internal Medicine, Hennepin County Medical Center, Hennepin County Medical Center, S2.309, 701 Park Ave, Minneapolis, MN, 55415, USA. tyler.winkelman@hcmed.org.
• ² Center for Patient and Provider Experience, Minneapolis Medical Research Foundation, Minneapolis, MN, USA. tyler.winkelman@hcmed.org.
• ³ Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA.
• ⁴ Department of Population Health, School of Medicine, New York University, New York, NY, USA.

• PMID: 29181792
• PMCID: PMC5834959
• DOI: 10.1007/s11606-017-4217-5

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Comparative Study

Tyler N A Winkelman et al. J Gen Intern Med. 2018 Mar.

• ¹ Division of General Internal Medicine, Hennepin County Medical Center, Hennepin County Medical Center, S2.309, 701 Park Ave, Minneapolis, MN, 55415, USA. tyler.winkelman@hcmed.org.
• ² Center for Patient and Provider Experience, Minneapolis Medical Research Foundation, Minneapolis, MN, USA. tyler.winkelman@hcmed.org.
• ³ Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA.
• ⁴ Department of Population Health, School of Medicine, New York University, New York, NY, USA.

• PMID: 29181792
• PMCID: PMC5834959
• DOI: 10.1007/s11606-017-4217-5

Item in Clipboard

Background: While the Affordable Care Act's (ACA) Medicaid expansion has increased insurance coverage, its effects on health outcomes have been mixed. This may be because previous research did not disaggregate mental and physical health or target populations most likely to benefit.

Objective: To examine the association between Medicaid expansion and changes in mental health, physical health, and access to care among low-income childless adults with and without chronic conditions.

Design: We used a difference-in-differences analytical framework to assess differential changes in self-reported health outcomes and access to care. We stratified our analyses by chronic condition status.

Participants: Childless adults, aged 18-64, with incomes below 138% of the federal poverty level in expansion (n = 69,620) and non-expansion states (n = 57,628).

Intervention: Active Medicaid expansion in state of residence.

Main measures: Self-reported general health; total days in past month with poor health, poor mental health, poor physical health, or health-related activity restrictions; disability; depression; insurance coverage; cost-related barriers; annual check-up; and personal doctor.

Key results: Medicaid expansion was associated with reductions in poor health days (-1.2 days [95% CI, -1.6,-0.7]) and days limited by poor health (-0.94 days [95% CI, -1.4,-0.43]), but only among adults with chronic conditions. Trends in general health measures appear to be driven by fewer poor mental health days (-1.1 days [95% CI, -1.6,-0.6]). Expansion was also associated with a reduction in depression diagnoses (-3.4 percentage points [95% CI, -6.1,-0.01]) among adults with chronic conditions. Expansion was associated with improvements in access to care for all adults.

Conclusions: Medicaid expansion was associated with substantial improvements in mental health and access to care among low-income adults with chronic conditions. These positive trends are likely to be reversed if Medicaid expansion is repealed.

PubMed Disclaimer

All authors declare that they have no conflict of interest.

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• ACA Medicaid Expansion Associated With Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence From the Health and Retirement Study.

  McInerney M, Winecoff R, Ayyagari P, Simon K, Bundorf MK. McInerney M, et al. Inquiry. 2020 Jan-Dec;57:46958020935229. doi: 10.1177/0046958020935229. Inquiry. 2020. PMID: 32720837 Free PMC article.

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