1
|
Barrero CE, Kavanagh NM, Pontell ME, Salinero LK, Wagner CS, Bartlett SP, Taylor JA, Swanson JW. Associations Between Medicaid Expansion and Timely Repair of Cleft Lip and Palate. J Craniofac Surg 2023; 34:2116-2120. [PMID: 37493139 DOI: 10.1097/scs.0000000000009524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/19/2023] [Indexed: 07/27/2023] Open
Abstract
The expansion of Medicaid under the Affordable Care Act (ACA) increased access to health care for many low-income children. However, the impact of this expansion on the timing of primary cleft lip and palate repair remains unclear. This study aimed to evaluate whether Medicaid expansion improved access to timely cleft lip and palate repair and whether it reduced preexisting ethnoracial disparities. Using a quasi-experimental design, the study analyzed data from 44 pediatric surgical centers across the United States. The results showed that Medicaid expansion was associated with a 9.0 percentage-point increase in delayed cleft lip repairs, resulting in an average delay of 16 days. Non-White patients were disproportionately affected by this delay, experiencing a 14.8 percentage-point increase compared with a 4.9 percentage-point increase for White patients. In contrast, Medicaid expansion had no significant effect on the timing of palate repair or on ethnoracial disparities in palate repair. The study underscores the importance of monitoring unintended consequences of large-scale health system changes, especially those affecting disadvantaged populations. Delayed cleft lip repair can lead to worse outcomes for patients, and the disproportionate impact on non-White patients is concerning. Further research is needed to identify the reasons for this delay and to mitigate its effects. Overall, the study highlights the need for ongoing vigilance to ensure that health care policies and interventions do not inadvertently worsen health disparities.
Collapse
Affiliation(s)
- Carlos E Barrero
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Matthew E Pontell
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lauren K Salinero
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Connor S Wagner
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Scott P Bartlett
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jesse A Taylor
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jordan W Swanson
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| |
Collapse
|
2
|
Bullinger LR, Gopalan M, Lombardi CM. Impacts of Publicly Funded Health Insurance for Adults on Children's Academic Achievement . SOUTHERN ECONOMIC JOURNAL 2023; 89:860-884. [PMID: 38845841 PMCID: PMC11156232 DOI: 10.1002/soej.12614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/24/2022] [Indexed: 06/09/2024]
Abstract
Empirical evidence demonstrates that publicly funded adult health insurance through the Affordable Care Act (ACA) has had positive effects on low-income adults. We examine whether the ACA's Medicaid expansions influenced child development and family functioning in low-income households. We use a difference-in-differences framework exploiting cross-state policy variation and focusing on children in low-income families from a nationally representative, longitudinal sample followed from kindergarten to fifth grade. The ACA Medicaid expansions improved children's reading test scores by approximately 2 percent (0.04 SD). Potential mechanisms for these effects within families are more time spent reading at home, less parental help with homework, and eating dinner together. We find no effects on children's math test scores or socioemotional skills.
Collapse
Affiliation(s)
| | - Maithreyi Gopalan
- Department of Education Policy Studies, Pennsylvania State University
| | | |
Collapse
|
3
|
Zengul FD, Oner N, Ozaydin B, Hall AG, Berner ES, Cimino JJ, Lemak CH. Mapping 2 Decades of Research in Health Services Research, Health Policy, and Health Economics Journals. Med Care 2022; 60:264-272. [PMID: 34984990 DOI: 10.1097/mlr.0000000000001685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify major research topics and exhibit trends in these topics in 15 health services research, health policy, and health economics journals over 2 decades. DATA SOURCES The study sample of 35,159 abstracts (1999-2020) were collected from PubMed for 15 journals. STUDY DESIGN The study used a 3-phase approach for text analyses: (1) developing the corpus of 40,618 references from PubMed (excluding 5459 of those without abstract or author information); (2) preprocessing and generating the term list using natural language processing to eliminate irrelevant textual data and identify important terms and phrases; (3) analyzing the preprocessed text data using latent semantic analysis, topic analyses, and multiple correspondence analysis. PRINCIPAL FINDINGS Application of analyses generated 16 major research topics: (1) implementation/intervention science; (2) HIV and women's health; (3) outcomes research and quality; (4) veterans/military studies; (5) provider/primary-care interventions; (6) geriatrics and formal/informal care; (7) policies and health outcomes; (8) medication treatment/therapy; (9) patient interventions; (10) health insurance legislation and policies; (11) public health policies; (12) literature reviews; (13) cost-effectiveness and economic evaluation; (14) cancer care; (15) workforce issues; and (16) socioeconomic status and disparities. The 2-dimensional map revealed that some journals have stronger associations with specific topics. Findings were not consistent with previous studies based on user perceptions. CONCLUSION Findings of this study can be used by the stakeholders of health services research, policy, and economics to develop future research agendas, target journal submissions, and generate interdisciplinary solutions by examining overlapping journals for particular topics.
Collapse
Affiliation(s)
| | | | | | | | | | - James J Cimino
- Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | | |
Collapse
|
4
|
Semprini J, Lyu W, Shane DM, Wehby GL. The Effects of ACA Medicaid Expansions on Health After 5 Years. Med Care Res Rev 2022; 79:28-35. [PMID: 33218289 PMCID: PMC8218574 DOI: 10.1177/1077558720972592] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We examine the Affordable Care Act Medicaid expansion effects on self-rated health status over 5 years. The study uses data from the Behavioral Risk Factor Surveillance System for 2011-2018 and a difference-in-differences design. There is improvement in health status on a 1 to 5 point scale from poor to excellent health among individuals below 100% of the federal poverty line by 0.031, 0.068, 0.031, 0.064, and 0.087 points in 2014, 2015, 2016, 2017, and 2018, respectively. Changes in 2015, 2017, and 2018 are statistically significant (p < .05), and the 2014 change is marginally significant. The difference between 2014 and 2018 effects is statistically significant (p < .05). In most years, we cannot distinguish changes in days not in good physical or mental health from no effect. Overall, there is only minimal evidence for effects intensifying over time, suggesting that health gains thus far have mostly occurred early on due to unmet needs among those previously uninsured.
Collapse
Affiliation(s)
- Jason Semprini
- Department of Health Management and Policy, University of Iowa, Iowa City, Iowa
| | - Wei Lyu
- Department of Health Management and Policy, University of Iowa, Iowa City, Iowa
| | - Dan M. Shane
- Department of Health Management and Policy, University of Iowa, Iowa City, Iowa,Department of Economics, University of Iowa, Iowa City, Iowa,Public Policy Center, University of Iowa, Iowa City, Iowa
| | - George L. Wehby
- Department of Health Management and Policy, University of Iowa, Iowa City, Iowa,Department of Economics, University of Iowa, Iowa City, Iowa,Public Policy Center, University of Iowa, Iowa City, Iowa,Department of Preventive & Community Dentistry, University of Iowa, Iowa City, Iowa,National Bureau of Economic Research, Cambridge, Massachusetts
| |
Collapse
|
5
|
Wehby GL. The Impact Of Household Health Insurance Coverage Gains On Children's Achievement In Iowa: Evidence From The ACA. Health Aff (Millwood) 2022; 41:35-43. [PMID: 34982630 DOI: 10.1377/hlthaff.2021.01222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Low family income is associated with worse child academic achievement. Little is known about how health insurance expansions affect children's achievement in low-income households. This study examined the effects of the Affordable Care Act's coverage expansions primarily for Medicaid and Marketplace enrollment, beginning in 2014, on children's academic achievement in Iowa. The study employed a unique linkage of birth certificates and data on standardized school tests for children in Iowa and took advantage of differences in uninsurance rates across areas in the state before the ACA insurance expansions. There is evidence that the ACA expansions beginning in 2014 were associated with higher reading scores after three years for children born to mothers with a high school education or less. There is no consistent evidence of an effect on math scores. Overall, these findings suggest broad spillover benefits from health insurance expansions to the well-being and development of children in low-income households that should be part of the continuing policy debate surrounding state and national health insurance reforms.
Collapse
Affiliation(s)
- George L Wehby
- George L. Wehby , University of Iowa, Iowa City, Iowa, and National Bureau of Economic Research, Cambridge, Massachusetts
| |
Collapse
|
6
|
Lyu W, Wehby GL. Effects of Virginia’s 2019 Medicaid Expansion on Health Insurance Coverage, Access to Care, and Health Status. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221092856. [PMID: 35604140 PMCID: PMC9134455 DOI: 10.1177/00469580221092856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Virginia expanded Medicaid under the Affordable Care Act beginning in January
2019, which substantially increased income eligibility up to 138% of the federal
poverty level (FPL) for both childless adults and parents. In this study, we
examined the effects of Virginia’s Medicaid expansion in 2019 on health
insurance coverage, access to care, and health status by employing a
difference-in-differences and a synthetic control design. The study included
data on health insurance from the 2016–2020 American Community Survey (ACS) and
data on access to care and health status come from the 2016–2020 Behavioral Risk
Factors Surveillance System (BRFSS). The samples from ACS and BRFSS were limited
to non-elderly adults with income below 138% of the FPL. Separate models were
estimated for individuals below 100% of FPL, and those within 100–138% of FPL.
The Virginia Medicaid expansion was associated with a 9–11 percentage-point
increase in Medicaid coverage rate and a 7–8 percentage-point increase in the
insured rate among individuals below 100% FPL, in the first two years of
expansion. There was a larger increase in Medicaid coverage among individuals
within 100–138% of FPL which also led to a larger increase in the insured rate
in 2020. Both income groups showed no changes in private coverage after the
expansion in Virginia. We also found a decline in delaying necessary medical
visits due to cost for individuals below 100% FPL in 2019 and for individuals
within 100–138% FPL in 2020. There was overall no discernable change in health
status outcomes. Virginia’s 2019 Medicaid expansion substantially increased
insurance coverage among poor adults with suggestive early evidence for improved
access. The findings highlight the missed opportunity for other states that have
not yet decided to expand their Medicaid programs to improve coverage and access
among their low-income individuals.
Collapse
Affiliation(s)
- Wei Lyu
- Division of Health Systems Management
and Policy, University of Memphis, Memphis, TN, USA
- Wei Lyu, PhD, Division of Health Systems
Management and Policy, The University of Memphis, 3825 Desoto Avenue, 124
Robison Hall, Memphis, TN 38152, USA.
| | - George L. Wehby
- Department of Health Management and
Policy, University of Iowa, Iowa City, IA, USA
- Department of Economics, University of
Iowa, Iowa City, IA, USA
- Department of Preventive &
Community Dentistry, University of Iowa, Iowa City, IA, USA
- Public Policy Center, University of
Iowa, Iowa City, IA, USA
- National Bureau of Economic Research,
Cambridge, MA, USA
| |
Collapse
|
7
|
National Trends in the Expenditure and Utilization of Chiropractic Care in U.S. Children and Adolescents From the 2007-2016 Medical Expenditure Panel Survey: A Cross Sectional Study. J Manipulative Physiol Ther 2021; 44:591-600. [DOI: 10.1016/j.jmpt.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 11/24/2022]
|
8
|
Benitez J, Williams T, Goldstein E, Seiber EE. The Relationship Between Unemployment and Health Insurance Coverage: Before and After the Affordable Care Act's Coverage Expansions. Med Care 2021; 59:768-777. [PMID: 34310457 DOI: 10.1097/mlr.0000000000001603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether the Affordable Care Act's (ACA) major coverage expansions mitigated the impact of unemployment on health insurance coverage status. DATA SOURCE A 2011-2019 versions of the American Community Survey developed by the University of Minnesota Integrated Public Use Microdata Series program. RESEARCH DESIGN We use difference-in-difference-in-differences (ie, triple difference) regressions to compare changes in the short-run impacts of local unemployment rates before and after the ACA. PRINCIPAL FINDINGS Before the ACA, rises in local unemployment were associated with uninsurance due to losses in private coverage (ie, both nongroup and employer sponsored).Following the ACA's full implementation, the link between employment and coverage was attenuated by access to publicly subsidized qualified health plans on the ACA's nongroup market, and enhanced access to Medicaid in states that expanded. Our findings suggest protections from unemployment-linked uninsured spells are largest in states that expanded Medicaid. CONCLUSIONS Expanded access to coverage under the ACA could mitigate the adverse effects on insurance status and access to care historically linked to job loss. However, should the ACA be repealed, many households stand to lose their ability to turn to Medicaid or subsidized nongroup coverage as safety-net resources to offset the burdens of job loss.
Collapse
Affiliation(s)
- Joseph Benitez
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY
| | - Timothy Williams
- The Hilltop Institute, University of Maryland Baltimore County, Baltimore, MD
| | - Evan Goldstein
- Division of Health, Services Management and Policy, College of Public Health, Ohio State University, Columbus, OH
| | - Eric E Seiber
- Division of Health, Services Management and Policy, College of Public Health, Ohio State University, Columbus, OH
| |
Collapse
|
9
|
Sheth A, Agrawal R. Trends in Pediatric Private Insurance and Medicaid Spending: A Repeated Cross-Sectional Analysis of Data from 2002 to 2014. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211010433. [PMID: 33978508 PMCID: PMC8120517 DOI: 10.1177/00469580211010433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Given increased focus on health spending, this investigation aims to compare trends in pediatric Medicaid and private insurance spending on type of service from 2002 to 2014 in order to inform policy and research. A repeated cross-sectional analysis of 2002 to 2014 National Health Expenditure Accounts data was conducted. Total spending, per capita spending, and compounded annual growth rates for type of service were determined for children ages 0 to 18 at the national level. Per capita spending growth was higher for private insurance than for Medicaid, and the areas of high per capita spending growth differed for private insurance and Medicaid. While Medicaid spent more per capita on hospital care than private insurance, private insurance demonstrated greater per capita spending growth on hospital care than Medicaid (8.49% vs 1.99%, respectively). Conversely, per capita spending on home health care grew more for Medicaid (6.79%) than for private insurance (3.18%). Trends in private insurance and Medicaid overall and per capita spending differ. Medicaid experienced higher annual growth in total spending than per capita spending, while private insurance had greater annual growth in per capita spending than total spending. Growth in private insurance per capita spending was higher than growth in Medicaid per capita spending, but growth in Medicaid total spending was higher than growth in private insurance total spending. These data suggest that Medicaid and private insurance may have different drivers of spending growth, highlighting the need for policy makers to examine spending patterns by payer. Further research to determine why such differences in spending growth exist will better inform efforts to increase health care value.
Collapse
Affiliation(s)
| | - Rishi Agrawal
- Northwestern University, Chicago, IL, USA.,Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| |
Collapse
|
10
|
Lyu W, Wehby GL. Heterogeneous Effects of Affordable Care Act Medicaid Expansions Among Women with Dependent Children by State-Level Pre-Expansion Eligibility. J Womens Health (Larchmt) 2021; 30:1278-1287. [PMID: 33555950 DOI: 10.1089/jwh.2020.8776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Objectives: This study explores the heterogeneity in effects of the 2014 Affordable Care Act (ACA) Medicaid expansions on insurance coverage, health care access, and health status of low-income women with dependent children by pre-expansion state-level income eligibility. Materials and Methods: We employ a quasiexperimental difference-in-differences design comparing outcome changes in Medicaid expansion states to nonexpansion states. We estimate effects separately for three groups of expansion states based on pre-expansion (2013) parent income eligibility: low pre-expansion eligibility (<90% of federal poverty level [FPL]), high eligibility (90% to <138% FPL), and full eligibility (≥138% FPL). Study samples include women with dependent children below 138% FPL from the 2011 to 2018 American Community Survey for the insurance outcomes, and from the 2011 to 2018 Behavioral Risk Surveillance System for the access and health outcomes. Results: There is stark heterogeneity in changes of health insurance and health care access by pre-expansion income eligibility levels. In comparison to Medicaid non-expansion states, there are large increases in insured rate (9 percentage-points) and Medicaid coverage (16 percentage-points) in expansion states with low pre-expansion eligibility. Insurance changes are much smaller in states with high or full pre-expansion eligibility. Changes in access largely mirror those in coverage. There are no significant changes in health status regardless of pre-expansion eligibility. Conclusions: The ACA Medicaid expansions increased coverage and access for low-income women with dependent children primarily in states with low pre-expansion parent eligibility, and therefore, reduced differences in these outcomes between expansion states.
Collapse
Affiliation(s)
- Wei Lyu
- Division of Health Systems Management and Policy, University of Memphis, Memphis, Tennessee, USA.,Department of Health Management and Policy, University of Iowa, Iowa City, Iowa, USA
| | - George L Wehby
- Department of Health Management and Policy, University of Iowa, Iowa City, Iowa, USA.,Department of Economics, and University of Iowa, Iowa City, Iowa, USA.,Department of Preventive and Community Dentistry, University of Iowa, Iowa City, Iowa, USA.,Public Policy Center, University of Iowa, Iowa City, Iowa, USA.,National Bureau of Economic Research, Cambridge, Massachusetts, USA
| |
Collapse
|
11
|
Ye W, Rodriguez JM. Highly vulnerable communities and the Affordable Care Act: Health insurance coverage effects, 2010-2018. Soc Sci Med 2021; 270:113670. [PMID: 33450469 DOI: 10.1016/j.socscimed.2021.113670] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/22/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022]
Abstract
Initially implemented in 2014 in some U.S. states, the Medicaid expansions under the Affordable Care Act (ACA) aimed to make health insurance coverage more accessible to the low-income population. This paper aims to quantify the impact of the ACA Medicaid expansions on insurance coverage among racial/ethnic minorities, immigrants, single mothers, veterans, and low-education whites-i.e., the sectors of the population identified with some of the highest healthcare needs. We focus on individuals 18-64 years of age earning 138% or less of the federal poverty level from the American Community Survey, 2010-2018 (n = 2,927,402). We use difference-in-differences (DD) and difference-in-difference-in-differences (DDD) approaches with propensity scores matched comparison groups to estimate pre-post ACA insurance coverage differences between individuals living in states that participated in the ACA Medicaid expansions and those living in non-participating states, and to estimate if such differences vary across subgroups. We find that insurance coverage rates increased for all subgroups; yet, the ACA benefits have not been evenly distributed across them. Low-education whites, non-Hispanic whites, females, and non-Hispanic Native Americans exhibited the highest improvements in insurance coverage. Our results contribute to the understanding of recent trends in racial and socioeconomic disparities in healthcare and the appropriate policy prescriptions to ameliorate them.
Collapse
Affiliation(s)
- Wei Ye
- Claremont Graduate University, United States
| | | |
Collapse
|
12
|
Szilagyi PG, Albertin CS, Gurfinkel D, Saville AW, Vangala S, Rice JD, Helmkamp L, Zimet GD, Valderrama R, Breck A, Rand CM, Humiston SG, Kempe A. Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US. Vaccine 2020; 38:6027-6037. [PMID: 32758380 DOI: 10.1016/j.vaccine.2020.06.074] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND While many clinicians encounter parents or adolescents who refuse HPV vaccine, little is known about the prevalence of hesitancy for HPV vaccine nationally or its association with vaccination. METHODS In April 2019, we surveyed families with adolescents 11-17 years using a national online panel (Knowledge Panel®) as the sampling frame. We assessed the prevalence of HPV vaccine hesitancy with the validated 9-item Vaccine Hesitancy Scale (VHS). We used multivariate analyses to assess demographic factors associated with HPV vaccine hesitancy. We also assessed practical barriers to receipt of HPV vaccine and the relationship between barriers and hesitancy. Finally, we evaluated the association between both HPV vaccine hesitancy and practical barriers on HPV vaccine receipt or refusal. RESULTS 2,177 parents out of 4,185 sampled (52%) completed the survey, 2,020 qualified (lived with adolescent). Using a VHS cut-off score > 3 out of 5 points, 23% of US parents were hesitant about HPV vaccine. Hesitancy was lower among those with Hispanic ethnicity. At least one out of five parents disagreed that the HPV vaccine is beneficial for their adolescent, that the vaccine is effective, protects against HPV-related cancers, or that they followed their adolescent's health-care provider's recommendation about the vaccine. Many were concerned about vaccine side effects and the novelty of the vaccine. Adolescents living with vaccine-hesitant parents were less than one-third as likely to have received the vaccine (RR = 0.29, 95% CI 0.24, 0.35) or completed the vaccine series (RR = 0.29, 95% CI 0.23, 0.36), and were 6-fold more likely to have refused the vaccine because of parental vaccine-related concerns (RR = 6.09, 95% CI = 5.26, 7.04). Most practical barriers were independently associated with vaccine receipt but not with vaccine refusal. CONCLUSIONS HPV vaccine hesitancy is common nationally and strongly related to both under-vaccination and vaccine refusal.
Collapse
Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Christina S Albertin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Dennis Gurfinkel
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Alison W Saville
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Sitaram Vangala
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - John D Rice
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA.
| | - Laura Helmkamp
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Rebecca Valderrama
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA
| | - Abigail Breck
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Cynthia M Rand
- Department of Pediatrics, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA.
| | | | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| |
Collapse
|
13
|
Barnes JM, Barker AR, King AA, Johnson KJ. Association of Medicaid Expansion With Insurance Coverage Among Children With Cancer. JAMA Pediatr 2020; 174:581-591. [PMID: 32202616 PMCID: PMC7091454 DOI: 10.1001/jamapediatrics.2020.0052] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
IMPORTANCE Despite evidence of improved insurance coverage under the Affordable Care Act and Medicaid expansion among adults with cancer, little is known regarding the association of these policies with coverage among children with cancer. OBJECTIVE To assess the association of early Medicaid expansion with rates of Medicaid coverage, private coverage, and no uninsurance among children with cancer. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the Surveillance, Epidemiology, and End Results (SEER) database from January 1, 2007, to December 31, 2015, to identify children diagnosed with cancer at ages 0 to 14 years in the United States. Data were analyzed from July 27, 2017, to October 7, 2019. EXPOSURES Changes in insurance status at diagnosis after early Medicaid expansion in California, Connecticut, Washington, and New Jersey (EXP states) were compared with changes in nonexpansion (NEXP) states (Arkansas, Georgia, Hawaii, Iowa, Kentucky, Louisiana, Michigan, New Mexico, and Utah). MAIN OUTCOMES AND MEASURES Difference-in-differences (DID) analyses were used to compare absolute changes in insurance status (uninsured, Medicaid, private/other) at diagnosis before (2007 to 2009) and after (2011 to 2015) expansion in EXP relative to NEXP states. RESULTS A total of 21 069 children (11 265 [53.5%] male; mean [SD] age, 6.18 [4.57] years) were included. A 5.25% increase (95% CI, 2.61%-7.89%; P < .001) in Medicaid coverage in children with cancer was observed in EXP vs NEXP states, with larger increases among children of counties with middle to high (adjusted DID estimates, 10.18%; 95% CI, 4.22%-16.14%; P = .005) and high (adjusted DID estimates, 6.13%; 95% CI, 1.10%-11.15%; P = .05) poverty levels (P = .04 for interaction). Expansion-associated reductions of children reported as uninsured (-0.73%; 95% CI, -1.49% to 0.03%; P = .06) and with private or other insurance (-4.52%; 95% CI, -7.16% to -1.88%; P < .001) were observed. For the latter, the decrease was greater for children from counties with middle to high poverty (-9.00%; 95% CI, -14.98% to -3.02%) and high poverty (-6.38%; 95% CI, -11.36% to -1.40%) (P = .04 for interaction). CONCLUSIONS AND RELEVANCE In this study, state Medicaid expansions were associated with increased Medicaid coverage in children with cancer overall and in some subgroups primarily owing to switching from private coverage, particularly in counties with higher levels of poverty but also through reductions in the uninsured.
Collapse
Affiliation(s)
- Justin M. Barnes
- Medical student, Saint Louis University School of Medicine, St Louis, Missouri
| | - Abigail R. Barker
- Brown School Master of Public Health Program, Washington University in St Louis, St Louis, Missouri,Center for Health Economics and Policy, Institute for Public Health, Washington University in St Louis, St Louis, Missouri
| | - Allison A. King
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, Missouri,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri,Department of Pediatrics Hematology/Oncology, St Louis Children’s Hospital, Washington University School of Medicine, St Louis, Missouri,Siteman Cancer Center, Washington University in St Louis, St Louis, Missouri
| | - Kimberly J. Johnson
- Brown School Master of Public Health Program, Washington University in St Louis, St Louis, Missouri,Siteman Cancer Center, Washington University in St Louis, St Louis, Missouri
| |
Collapse
|