title: The effect of medicaid expansion in new york state on use of subspecialty surgical procedures by medicaid beneficiaries and the uninsured.
abstract: BACKGROUND
  Understanding the benefits of Medicaid is crucial as states decide whether to expand Medicaid under the Patient Protection and Affordable Care Act. We used the 2001 Medicaid expansion in New York to evaluate changes in use by Medicaid beneficiaries and the uninsured of breast cancer reconstruction, panniculectomy, and lower-extremity trauma management.
  
  
  METHODS
  Data for all patients 19 to 64 years old having undergone the selected procedures between 1998 and 2006 were obtained from the State Inpatient Database. We used an interrupted time series using variance weighted least squares regression to evaluate the effect of Medicaid expansion on the probability that Medicaid beneficiaries or uninsured patients received the procedures. We also determined the predicted use had there been no expansion. New York Census data were used for population-adjusted case-volume calculations.
  
  
  RESULTS
  Likelihood of Medicaid as the primary payer increased significantly after expansion, 0.34% per quarter (95% CI, 0.28-0.40), without a decrease in uninsured patients receiving these procedures. This resulted in a 7.2% increase in the proportion of Medicaid beneficiaries receiving these procedures, an additional 1.9 Medicaid cases per quarter per 100,000 New York residents. In subgroup analysis, the proportion of Medicaid beneficiaries increased for breast reconstruction (0.28% per quarter; 95% CI, 0.21-0.35) and panniculectomy (0.19% per quarter; 95% CI, 0.1-0.28) without a decrease for the uninsured. Lower-extremity trauma procedures had a decreasing trend in use by uninsured patients with a slight increase for Medicaid beneficiaries (not significant).
  
  
  CONCLUSIONS
  Subspecialty surgeons responded to expansion by increasing volume of procedures for Medicaid beneficiaries. This occurred without decline in care for the uninsured, suggesting that Medicaid expansion resulted in increased access for underserved patients. Although more patients received needed care once they had coverage, subgroup analysis identified persistence of additional barriers to use of certain surgical services.
authors.affiliation: Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Aviram M
authors.initials: AM
authors.lastname: Giladi
authors.affiliation: Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Oluseyi
authors.initials: O
authors.lastname: Aliu
authors.affiliation: Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI. Electronic address: kecchung@med.umich.edu.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D000328:Adult; D005260:Female; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000458:organization & administration*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D009518:New York; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000191:economics*; D014481:United States; D055815:Young Adult