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• W2530481343 abstract "To examine local changes in health insurance coverage and emergency department (ED) use after Affordable Care Act (ACA) mandated health insurance expansion in Illinois. We hypothesize that the impact of the ACA would vary widely across local areas with an increase in ED visits for those with growth in Medicaid coverage. We performed a retrospective analysis using the annual American Community Survey (ACS) data to capture rates of insurance coverage and statewide hospital administrative data to capture ED visit rates across 88 public use microdata areas (PUMAs) in Illinois for adults (18-64 years) during ACA implementation. Using patient zip codes, visit level data were mapped by PUMA. Mean differences between pre-ACA (2012-2013) and post-ACA (2014-2015) were calculated for each insurance category by PUMA. Bivariate correlations between population changes in insurance coverage by and changes in ED visit rates by PUMA were calculated to evaluate for change in insurance coverage by payer and change in ED visits by insurance-type. Linear regression was performed to test the joint effects of all changes in insurance coverage on local ED visit rate. Pre-ACA insurance coverage varied widely across the 88 PUMAs: 31.5% - 90.3% for private insurance, 2.0% - 29.9% for Medicaid, and 6.7% - 41.1% for uninsured. Changes in insurance coverage post-ACA also varied by PUMA: -4.2% to 8.1% for private, -1.7% to 8.5% for Medicaid, and -11.6% to 3.0% for uninsured. Pre-ACA ED visit rates varied by PUMA from 13.5-62.3 per 1000 residents. Changes in ED visit rates post-ACA varied by PUMA from -3.1 to 9.8 per 1000 residents, with significant variation in ED visit rate by insurance status (Table 1). Pearson correlation coefficient between change in coverage and change in mean monthly ED visit rates by insurance type are: 0.26 (p=0.01) for uninsured, 0.51 (p<0.001) for Medicaid, 0.02 (p=0.87) for Private insurance, and 0.23 (p=0.03) for Medicare. Linear regression beta coefficients adjusting concomitant changes in insurance coverage by PUMA are: 0.06 (p=0.84) for uninsured, 0.56 (p=0.04) for Medicaid, 0.11 (p=0.72) for Private Insurance, and 0.47 (p=0.34) for Medicare. There were wide variations across PUMAs in baseline insurance coverage, ED visit rates, and post-ACA changes in insurance coverage and ED visit rates by insurance-type. After adjusting for multiple changes in local insurance coverage, only change in Medicaid coverage was positively associated with increased ED visits. ED visit rates grew fastest in communities with the largest growth in Medicaid coverage, which suggests these communities may have challenges in primary care access and care coordination.Tabled 1Change in ED visit rates after Health Insurance Expansion across 88 Public Use Microdata AreasMonthly Visit Rate (per 1000 residents)Mean (SD)Minimum RateMaximum RateTotalPre-ACA31.2 (12.3)13.562.3TotalPost-ACA32.6 (12.4)13.664.5TotalChange1.4 (2.4)-3.19.8UninsuredPre-ACA7.1 (2.1)2.119.4UninsuredPost-ACA4.0 (3.9)1.212.6UninsuredChange-3.1 (2.2)-11.3-0.3MedicaidPre-ACA8.6 (5.2)1.221.8MedicaidPost-ACA12.1 (7.5)1.929.6MedicaidChange3.5 (2.8)-1.512.0ACA = Affordable Care Act Open table in a new tab" @default.
• W2530481343 created "2016-10-21" @default.
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• W2530481343 date "2016-10-01" @default.
• W2530481343 modified "2023-10-14" @default.
• W2530481343 title "132EMF Changes in Insurance Coverage and Hospital Emergency Department Use Across Community Areas After Implementation of the Affordable Care Act" @default.
• W2530481343 doi "https://doi.org/10.1016/j.annemergmed.2016.08.144" @default.
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