title: The effect of pre-Affordable Care Act (ACA) Medicaid eligibility expansion in New York State on access to specialty surgical care.
abstract: BACKGROUND
  Critics argue that expanding health insurance coverage through Medicaid may not result in improved access to care. The Affordable Care Act provides reimbursement incentives aimed at improving access to primary care services for new Medicaid beneficiaries; however, there are no such incentives for specialty services. Using the natural experiment of Medicaid expansion in New York (NY) State in October 2001, we examined whether Medicaid expansion increased access to common musculoskeletal procedures for Medicaid beneficiaries.
  
  
  METHODS
  From the State Inpatient Database for NY State, we identified 19- to 64-year-old patients who underwent lower extremity large joint replacement, spine procedures, and upper/lower extremity fracture/dislocation repair from January 1998 to December 2006. We used interrupted time series analysis to evaluate the association between Medicaid expansion and trends in the relative and absolute number of Medicaid beneficiaries who underwent these musculoskeletal procedures.
  
  
  RESULTS
  Before Medicaid expansion, we observed a slight but steady temporal decline in the proportion of musculoskeletal surgical patients who were Medicaid beneficiaries. After expansion, this trend reversed, and by 5 years after Medicaid expansion, the proportion of musculoskeletal surgical patients who were Medicaid beneficiaries was 4.7 percentage points [95% confidence interval, 3.9-5.5] higher than expected, based on the preexpansion time trend.
  
  
  CONCLUSIONS
  Medicaid expansion in NY State significantly improved access to common musculoskeletal procedures for Medicaid beneficiaries.
authors.affiliation: *Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI †Division of Hospital Medicine and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH ‡Partnership for Health Analytic Research, LLC, Beverly Hills, CA Departments of §Neurology ∥Internal Medicine ¶Section of Plastic Surgery, Department of Surgery #Department of Internal Medicine, The University of Michigan Health System **VA Center for Clinical Management Research, Ann Arbor, MI.
authors.forename: Oluseyi
authors.initials: O
authors.lastname: Aliu
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Auger
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Sun
authors.forename: James F
authors.initials: JF
authors.lastname: Burke
authors.forename: Colin R
authors.initials: CR
authors.lastname: Cooke
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Hayward
mesh_terms: D000328:Adult; D000367:Age Factors; D004608:Eligibility Determination / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid / Q000458:organization & administration* / Q000706:statistics & numerical data*; D008875:Middle Aged; D009518:New York; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act; D011320:Primary Health Care / Q000706:statistics & numerical data; D012737:Sex Factors; D014481:United States