Megan B. Cole (
Brad Wright is an associate professor in the Department of Health Management and Policy at the University of Iowa College of Public Health, in Iowa City.
Health Aff (Millwood). 2018 Jun;37(6):900-907. doi: 10.1377/hlthaff.2017.1542.
Medicaid expansion had great potential to affect community health centers (CHCs), particularly in rural areas, because their patients are predominantly low income and disproportionately uninsured. Using data for 2011-15 on all CHCs, we found that after two years Medicaid expansion was associated with an 11.44-percentage-point decline in the share of CHC patients who were uninsured and a 13.15-percentage-point increase in the share with Medicaid. Changes in quality and volume were consistently observed in rural CHCs in expansion states, which had relative improvements in asthma treatment, body mass index screening and follow-up, and hypertension control, along with substantial increases in volumes for eighteen of twenty-one types of visits-particularly those for mammograms, abnormal breast findings, alcohol-related disorder, and other substance abuse disorder. Similar relative gains were not observed in urban CHCs in expansion states. Repealing or phasing out Medicaid expansion could reverse observed gains in quality and service use and could be particularly detrimental to low-income rural populations.
医疗补助计划的扩大对社区卫生中心（CHC）有很大的影响，特别是在农村地区，因为这些中心的患者主要是低收入和无保险的人群。利用 2011-2015 年所有 CHC 的数据，我们发现，在两年后，医疗补助计划的扩大与 CHC 中无保险患者的比例下降了 11.44 个百分点，而拥有医疗补助的患者比例则增加了 13.15 个百分点。在扩大医疗补助计划的州，农村 CHC 中的质量和数量都发生了变化，在哮喘治疗、体重指数筛查和随访以及高血压控制方面都有了相对的改善，同时，21 种就诊类型中的 18 种就诊量都有了大幅增加，特别是乳房 X 光检查、乳房异常发现、酒精相关障碍和其他物质滥用障碍的就诊量。在扩大医疗补助计划的州的城市 CHC 中，没有观察到类似的相对收益。废除或逐步取消医疗补助计划的扩大可能会逆转观察到的质量和服务使用方面的收益，并且可能对农村低收入人群造成特别不利的影响。
