Social and Behavioral Sciences Commons^™

Medicaid Expansion: The Choice Afforded To States By The Affordable Care Act, Robert M. Hatfield

MPA/MPP/MPFM Capstone Projects

The issue I studied is the decision states have been afforded to expand Medicaid with the Affordable Care Act (ACA). I was curious to determine the health and economic impact on states that have and have not chosen to expand Medicaid. Specifically, I targeted Kentucky (expansion state) and Tennessee (non-expansion state). Tennessee and Kentucky are similar populations, have similar political inclinations, and are both very rural states. At its core, Medicaid expansion is an opportunity to improve health for lower-income and disabled Americans. However, there are economic implications associated with Medicaid expansion as well. The goal of this research is …

Measuring The Impact Of The Affordable Care Act Medicaid Expansion On Access To Primary Care Using An Interrupted Time Series Approach, Elizabeth A. Brown, Brandi M. White, Walter J. Jones, Mulugeta Gebregziabher, Kit N. Simpson

Health and Clinical Sciences Faculty Publications

BACKGROUND: The Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act (ACA), was created to increase access to primary care, improve quality of care, and decrease healthcare costs. A key provision in the law that mandated expansion of state Medicaid programme changed when states were given the option to voluntarily expand Medicaid. Our study sought to measure the impact of ACA Medicaid expansion on preventable hospitalization (PH) rates, a measure of access to primary care.

METHODS: We performed an interrupted time series analysis of quarterly hospitalization rates across eight states from 2012 to …

The Affordable Care Act And Medication-Assisted Treatment Accessibility: A Context-Inclusive Review Of Research, Jacob Blevins

MPA/MPP/MPFM Capstone Projects

This paper provides a contextual review of research investigating associations between the health insurance reforms implemented by the Affordable Care Act and the accessibility and utilization of medication-assisted treatment for opioid use disorder. Research indicates that relative to 2008, the year of initial Medicaid expansions in 2014 is nationally associated with increased rates of insurance coverage, increased rates of treatment, and reduced rates of individuals with opioid use disorder forgoing treatment due to financial concerns (McKenna 2017). Between the year prior to state Medicaid expansion and the third year after it, the number of specialty treatment admissions related to the …

The State House And The White House: Gubernatorial Rhetoric During The Obama Administration, Austin Peyton Trantham

Theses and Dissertations--Political Science

What is the importance of political speechmaking? Do state governors discuss presidential priorities? This study addresses these questions by analyzing the contents of annual State of the State addresses given by governors from 2012 to 2014 during the presidency of Barack Obama. A descriptive paper provides evidence that governors primarily discuss employment and economic issues in their addresses, are discussing greater number of policy issues than in previous decades, and are delivering their address before the presidential State of the Union message. Examining health care and immigration policy in separate empirical papers, I theorize that contextual factors, including legislative partisanship, …

Financial Implications Of The Medicaid Expansion For Academic Medical Centers, Madeleine Oritt

MPA/MPP/MPFM Capstone Projects

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (ACA), with the goal of reforming the United States health care system and providing insurance for millions of uninsured citizens and residents. One component of the legislation was the expansion of Medicaid eligibility, which would extend to include all individuals “under age 65 whose family income is at or below 138 percent of the federal poverty guidelines ($14,484 for an individual and $29,726 for a family of four in 2011)” (NCSL, 2015). This provision was challenged in the United States Supreme Court, which ruled …

Aca Implementation In The South: The Political Economy Of Full Participation In Kentucky, Glen P. Mays

Health Management and Policy Presentations

This analysis, conducted as part of the ACA Implementation Research Network, examines economic and political forces shaping Kentucky's early experience with implementation of the Patient Protection and Affordable Care Act.

The Dynamics Of Medicaid & Public Health Spending: Implications For Aca Implementation, Glen P. Mays

Health Management and Policy Presentations

We estimate the dynamics and interactions of governmental spending on Medicaid and other public health services in all 50 states over a 15 year period. Using a quasi-experimental design with instrumental variables estimation, we find evidence that increased Medicaid spending leads to reduced governmental spending on other public health services, consistent with a crowd-out effect. Over 10 years, such crowd-out has the potential to diminish the health status improvements generated through health insurance coverage expansions.

Aca Implementation In Kentucky: Experiences Of An Expansion State, Glen P. Mays

Health Management and Policy Presentations

Kentucky's implementation of the Affordable Care Act has included early successes with insurance coverage expansion through Medicaid and a state-operated health insurance exchange. Signals of improvements in health care accessibility and delivery of preventive services are evident in the first year after coverage expansions. Challenges associated with political opposition, delivery system transformation, and public health financing remain on the state's policy agenda.

The Effects Of The Changes In Section 317 Rules For Administration Of Federally Purchased Vaccines, Margaret A. Knight, Anne D. Kershenbaum, Martha Buchanan, Janet Ridley, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

Section 317 of the Public Health Services Act is a federal program that provides funds for the purchase of vaccines. These annual Congressional allocations fluctuate from year to year as Congress responds to changes in national needs for immunizations. The Affordable Care Act requires first dollar coverage of immunizations and other preventive care, allowing a reduction in federal funding for vaccine purchase and a reallocation of funds to other uses such as infrastructure development. In fiscal year 2013, Section 317 rules redefined the population eligible for immunization with Section 317 purchased vaccines. In Tennessee, the response was a policy change …

The Patient Protection And Affordable Care Act’S Effects On Patterns Of Coverage In A Ryan White Funded Hiv Clinic: What Are The Implications For The Bluegrass Care Clinic?, Jacqueline Wagner Mccuddy

MPA/MPP/MPFM Capstone Projects

The Ryan White CARE Act of 1991 implemented a federal grant program to help individuals in the US with HIV/AIDS get access to healthcare and diminish barriers to care. Since its enactment, there have been many changes in the environment of HIV/AIDS, including a demographic shift in those most affected by the disease and a growing number of new infections, the introduction of Antiretroviral therapy, and most recently, the implementation of the Patient Protection and Affordable Care Act (PPACA).

The PPACA is expected to have a positive effect on patients with HIV in the US by increasing access to care, …

The National Longitudinal Survey Of Public Health Systems: Selected Findings And Applications, Glen P. Mays

Health Management and Policy Presentations

This presentation reviews the National Longitudinal Survey of Public Health Systems and its applicability for monitoring the effects of the Affordable Care Act on public health delivery within the U.S.

Influential Determinants On The Time Of Adoption Of State-Based Healthcare Insurance Exchanges, Chris Record

MPA/MPP/MPFM Capstone Projects

The Patient Protection and Affordable Care Act of 2010 consists of several provisions designed to promote the obtainment of affordable health insurance coverage for all Americans. In order to facilitate access to information on available prices and policies for this coverage, the law requires states to decide whether to operate their own healthcare insurance exchange or join a partnership or federal exchange. While many states proceeded with the implementation of state-based exchanges despite a challenge to the law in the Supreme Court, other states did not. This paper explores the influence that certain and health market characteristics may have had …