Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Phipps 279, 600 N. Wolfe Street, Baltimore, MD, 21287-1281, USA.
Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
Matern Child Health J. 2019 Aug;23(8):1008-1024. doi: 10.1007/s10995-019-02731-6.
Objective A national debate is underway about the value of key provisions within the adult-oriented Affordable Care Act (ACA)-the individual mandate, expansion of Medicaid eligibility, and essential benefits. How these provisions affect child health insurance and access to care may help us anticipate how children may be affected if the ACA is repealed. We study Massachusetts health reform because it enacted these key provisions statewide in 2006. Methods We used a difference-in-differences (DD) approach to assess the impact of Massachusetts health reform on uninsurance and access to care among children 0-17 years in Massachusetts compared to children in other New England states. The National Survey of Children's Health provided the pre-reform year and two post-reform years (1 and 5 years post-reform). We analyzed outcomes for children overall and children previously and newly-eligible for Medicaid under Massachusetts health reform, adjusting for age, sex, race/ethnicity, non-English language, and having special health care needs. Results Compared to other New England states, Massachusetts's enactment of the individual mandate, Medicaid expansion, and essential benefits was associated with trends at 5 years post-reform toward lower uninsurance for children overall (DD = - 1.1, p-for-DD = 0.05), increased access to specialty care (DD = 7.7, p-for-DD = 0.06), but also with a decrease in access to preventive care (DD=-3.4, p-for-DD = 0.004). At 1 year post-reform, access to specialty care improved for children newly-Medicaid-eligible (DD = 18.3, p-for-DD = 0.03). Conclusions for Practice Adult-oriented health reforms may have reduced uninsurance and improved access to some types of care for children in Massachusetts. Repealing the ACA may produce modest detriments for children.
一场关于《平价医疗法案》（ACA）中成人导向条款（个人强制参保、扩大医疗补助资格和基本福利）价值的全国性辩论正在进行。这些条款如何影响儿童健康保险和获得医疗服务的机会，可能有助于我们预测如果ACA 被废除，儿童将受到怎样的影响。我们研究马萨诸塞州的医疗改革，是因为该州于 2006 年在全州范围内颁布了这些关键条款。
我们使用差异法（DD）来评估马萨诸塞州医疗改革对该州 0-17 岁儿童与新英格兰其他州儿童的未参保率和获得医疗服务的影响。全国儿童健康调查提供了改革前一年和改革后的两年（改革后 1 年和 5 年）的数据。我们分析了所有儿童和根据马萨诸塞州医疗改革新符合医疗补助资格的儿童的结果，调整了年龄、性别、种族/族裔、非英语语言和特殊医疗需求。
与新英格兰其他州相比，马萨诸塞州颁布个人强制参保、医疗补助扩大和基本福利与改革后 5 年的以下趋势有关：整体儿童未参保率下降（DD=-1.1，p-for-DD=0.05），专科医疗服务可及性提高（DD=7.7，p-for-DD=0.06），但预防性医疗服务可及性下降（DD=-3.4，p-for-DD=0.004）。改革后 1 年，新符合医疗补助资格的儿童的专科医疗服务可及性提高（DD=18.3，p-for-DD=0.03）。
成人导向的医疗改革可能降低了马萨诸塞州儿童的未参保率，并改善了某些类型的医疗服务可及性。废除 ACA 可能会给儿童带来适度的负面影响。
