Huguet Nathalie, Hoopes Megan J, Angier Heather, Marino Miguel, Holderness Heather, DeVoe Jennifer E
1 Oregon Health & Science University, Portland, OR, USA.
2 OCHIN Inc, Portland, OR, USA.
J Prim Care Community Health. 2017 Oct;8(4):206-212. doi: 10.1177/2150131917709403. Epub 2017 May 17.
It is crucial to understand the impact of the Affordable Care Act (ACA). This study assesses changes in insurance status of patients visiting community health centers (CHCs) comparing states that expanded Medicaid to those that did not.
Electronic health record data on 875,571 patients aged 19 to 64 years with ≥ 1 visit between 2012 and 2015 in 412 primary care CHCs in 9 expansion and 4 nonexpansion states. We assessed changes in rates of total, uninsured, Medicaid-insured, and privately insured primary care and preventive care visits; immunizations administered, and medications ordered.
Rates of uninsured visits decreased pre- to post-ACA, with greater drops in expansion (-57%) versus nonexpansion (-20%) states. Medicaid-insured visits increased 60% in expansion states while remaining unchanged in nonexpansion states. Privately insured visits were 2.7 times higher post-ACA in nonexpansion states with no increase in expansion states. Comparing 2015 with 2014: Uninsured visit rates continued to decrease in expansion (-28%) and nonexpansion states (-19%), Medicaid-insured rates did not significantly increase, and privately insured visits increased in nonexpansion states but did not change in expansion states.
Medicaid expansion and subsidies to purchase private coverage likely increased the accessibility of health insurance for patients who had previously not been able to access coverage.
了解《平价医疗法案》（ACA）的影响至关重要。本研究比较了扩大医疗补助的州和未扩大医疗补助的州，评估了就诊于社区健康中心（CHC）的患者保险状况的变化。
收集了2012年至2015年间，9个扩大医疗补助州和4个未扩大医疗补助州的412家初级保健社区健康中心中875571名年龄在19至64岁之间且就诊次数≥1次的患者的电子健康记录数据。我们评估了初级保健和预防性保健就诊的总就诊率、未参保就诊率、医疗补助参保就诊率和私人保险参保就诊率的变化；疫苗接种情况以及所开药物。
《平价医疗法案》实施前后，未参保就诊率有所下降，扩大医疗补助的州下降幅度更大（-57%），未扩大医疗补助的州下降幅度为（-20%）。扩大医疗补助的州中，医疗补助参保就诊率增加了60%，而未扩大医疗补助的州则保持不变。在未扩大医疗补助的州，《平价医疗法案》实施后私人保险参保就诊率提高了2.7倍，而扩大医疗补助的州则没有增加。将2015年与2014年进行比较：扩大医疗补助的州（-28%）和未扩大医疗补助的州（-19%）未参保就诊率持续下降，医疗补助参保率没有显著增加，未扩大医疗补助的州私人保险参保就诊率有所增加，但扩大医疗补助的州没有变化。
医疗补助的扩大以及购买私人保险的补贴可能提高了以前无法获得保险的患者获得医疗保险的可及性。
