Abstract
Objective
To evaluate changes in insurance status among emergency department (ED) patients presenting
in the two years immediately before and after full implementation of the Affordable
Care Act (ACA).
Methods
We evaluated National Hospital Ambulatory Medical Care Survey (NHAMCS) Emergency Department
public use data for 2012–2015, categorizing patients as having any insurance (private;
Medicare; Medicaid; workers' compensation) or no insurance. We compared the pre- and
post-ACA frequency of insurance coverage—overall and within the older (≥65), working-age
(18–64) and pediatric (<18) subpopulations—using unadjusted odds ratios with 95% confidence
intervals. We also conducted a difference-in-differences analysis comparing the change
in insurance coverage among working-age patients with that observed for older Medicare-eligible
patients, while controlling for sex, race and underlying temporal trends.
Results
Overall, the proportion of ED patients with any insurance did not significantly change
from 2012 to 2013 to 2014–2015 (74.2% vs 77.7%) but the proportion of working-age
adult patients with at least one form of insurance increased significantly, from 66.0%
to 71.8% (OR 1.31, CI: 1.13–1.52). The difference-in-differences analysis confirmed
the change in insurance coverage among working-age adults was greater than that seen
in the reference population of Medicare-eligible adults (AOR 1.70, CI: 1.29–2.23).
The increase was almost entirely attributable to increased Medicaid coverage.
Conclusion
In the first two years following full implementation of the ACA, there was a significant
increase in the proportion of working-age adult ED patients who had at least one form
of health insurance. The increase appeared primarily associated with expansion of
Medicaid.
Keywords
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Article Info
Publication History
Published online: December 18, 2018
Accepted:
December 17,
2018
Received in revised form:
December 16,
2018
Received:
November 13,
2018
Footnotes
☆GSO & LHB conceived and designed the study, and obtained and managed the data. LHB provided statistical advice on study design and analyzed the data; GSO, RAW, CZ & LHB reviewed and interpreted the data. GSO & LHB drafted the manuscript. GSO, RAW, CZ & LHB contributed substantially to the manuscript revision, and take responsibility for the paper as a whole.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
