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Disabil Health J. 2021 Jul;14(3):101099. doi: 10.1016/j.dhjo.2021.101099. Epub 2021 Apr 15.
States had flexibility in their implementation of the Patient Protection and Affordable Care Act (ACA) Medicaid expansions, which may have led to variation in coverage and changes in access to care for workers with disabilities.
OBJECTIVE/HYPOTHESIS: To examine differential trends in health insurance coverage and access to care among workers with disabilities by states' decisions about expanding Medicaid under the ACA.
We aggregated data from the National Health Interview Survey into groups by time period relative to ACA implementation: pre-ACA (2006-2009), early ACA (2010-2013), and later ACA (2014-2017). We produced health insurance and access statistics for each time period, by state-level Medicaid expansion status.
Uninsurance rates decreased after 2014 in all states, regardless of the state's decision whether to expand Medicaid. There was a substantial increase after 2014 in the share of workers with disabilities covered by Medicaid in states that expanded in that year; in other states, workers with disabilities experienced larger increases in privately purchased coverage. At the same time, the share of workers with disabilities reporting cost-related barriers to care declined markedly in 2014 Medicaid expansion states, but it increased slightly in the non-expansion states. Structural barriers to accessing care increased in all states, with the smallest increase in 2014 expansion states.
Medicaid coverage and cost-related access to care improved significantly among workers with disabilities in 2014 Medicaid expansion states, both overall and relative to workers with disabilities in non-expansion states.
各州在实施《患者保护与平价医疗法案》（ACA）的 Medicaid 扩展计划方面具有灵活性，这可能导致覆盖范围的差异，并改变残疾工人获得医疗服务的机会。
目的/假设：通过考察各州在 ACA 下扩大 Medicaid 方面的决策，研究残疾工人的医疗保险覆盖范围和获得医疗服务机会的差异趋势。
我们将国家健康访谈调查的数据按与 ACA 实施相关的时间周期分为以下组：ACA 之前（2006-2009 年）、早期 ACA（2010-2013 年）和后期 ACA（2014-2017 年）。我们按各州 Medicaid 扩展状况，为每个时间周期生成了健康保险和获得医疗服务的统计数据。
无论各州是否决定扩大 Medicaid，自 2014 年以来，所有州的未参保率都有所下降。在当年扩大 Medicaid 的州，残疾工人获得 Medicaid 覆盖的比例大幅增加；而在其他州，残疾工人的私人购买保险比例大幅增加。与此同时，在 2014 年 Medicaid 扩展州，报告因费用问题而导致无法获得医疗服务的残疾工人比例显著下降，但在非扩展州，这一比例略有上升。在所有州，获得医疗服务的结构性障碍都有所增加，其中 2014 年 Medicaid 扩展州的增幅最小。
在 2014 年 Medicaid 扩展州，残疾工人的 Medicaid 覆盖范围和获得医疗服务的费用相关机会显著改善，无论是总体情况还是与非扩展州的残疾工人相比，都有所改善。
