title: At Federally Funded Health Centers, Medicaid Expansion Was Associated With Improved Quality Of Care.
abstract: In 2014 many uninsured, low-income nonelderly adults gained access to health insurance in states that expanded Medicaid eligibility under the Affordable Care Act. Federally funded community health centers were likely to be particularly affected by this expansion because many of their patients were uninsured and low income. We used a difference-in-differences approach to compare changes among 1,057 such centers in expansion versus nonexpansion states from 2011 to 2014, in terms of their patients' insurance coverage, the number of patients they served, and the quality of care they provided. Medicaid expansion was associated with large increases (12 percentage points) in Medicaid coverage and corresponding declines (11 percentage points) in uninsurance rates. The numbers of patients served increased in both expansion and nonexpansion states, and the magnitude of increase did not differ significantly between the groups of states. Medicaid expansion was associated with improved quality on four of eight measures examined: asthma treatment, Pap testing, body mass index assessment, and hypertension control. This analysis suggests that states' decisions about Medicaid expansion have important consequences for health center patients, with expansion improving treatment and outcomes of chronic disease and bolstering the use of recommended preventive services.
authors.affiliation: Megan B. Cole (megan_cole@brown.edu) is a PhD candidate in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health, in Providence, Rhode Island.
authors.forename: Megan B
authors.initials: MB
authors.lastname: Cole
authors.affiliation: Omar Galárraga is an assistant professor in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health.
authors.forename: Omar
authors.initials: O
authors.lastname: Galárraga
authors.affiliation: Ira B. Wilson is a professor in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health.
authors.forename: Ira B
authors.initials: IB
authors.lastname: Wilson
authors.affiliation: Brad Wright is an assistant professor in the Department of Health Management and Policy at the University of Iowa College of Public Health, in Iowa City.
authors.forename: Brad
authors.initials: B
authors.lastname: Wright
authors.affiliation: Amal N. Trivedi is an associate professor in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health.
authors.forename: Amal N
authors.initials: AN
authors.lastname: Trivedi
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003151:Community Health Centers / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D017057:Medically Uninsured; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D011203:Poverty; D058996:Quality Improvement; D014481:United States
keywords: Health Reform; Insurance Coverage < Insurance; Medicaid; Quality Of Care; Safety-Net Systems