Association of the Affordable Care Act Medicaid Expansion with Trauma Outcomes and Access to Rehabilitation among Young Adults: Findings Overall, by Race and Ethnicity, and Community Income Level

• Published in: Journal of the American College of Surgeons Vol. 233; no. 6; pp. 776 - 793.e16
• Main Authors: Metzger, Gregory A., Asti, Lindsey, Quinn, John P., Chisolm, Deena J., Xiang, Henry, Deans, Katherine J., Cooper, Jennifer N.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2021
• Subjects: Adult; Cohort Studies; Female; Health Services Accessibility - economics; Health Services Accessibility - legislation & jurisprudence; Health Services Accessibility - statistics & numerical data; Healthcare Disparities - statistics & numerical data; Hospital Mortality; Humans; Insurance Coverage - legislation & jurisprudence; Insurance Coverage - statistics & numerical data; Male; Medicaid - economics; Medicaid - statistics & numerical data; Patient Protection and Affordable Care Act - legislation & jurisprudence; Patient Protection and Affordable Care Act - statistics & numerical data; Poverty - statistics & numerical data; United States; Vulnerable Populations - statistics & numerical data; Wounds and Injuries - economics; Wounds and Injuries - mortality; Wounds and Injuries - rehabilitation; Young Adult; United States; DD; LOS; CMS; ISS; ACA; ED; SID
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2021.08.694

Low-income young adults disproportionately experience traumatic injury and poor trauma outcomes. This study aimed to evaluate the effects of the Affordable Care Act's Medicaid expansion, in its first 4 years, on trauma care and outcomes in young adults, overall and by race, ethnicity, and ZIP code-level median income.
Statewide hospital discharge data from 5 states that did and 5 states that did not implement Medicaid expansion were used to perform difference-in-difference (DD) analyses. Changes in insurance coverage and outcomes from before (2011-2013) to after (2014-2017) Medicaid expansion and open enrollment were examined in trauma patients aged 19 to 44 years.
Medicaid expansion was associated with a decrease in the percentage of uninsured patients (DD –16.5 percentage points; 95% CI, –17.1 to –15.9 percentage points). This decrease was larger among Black patients but smaller among Hispanic patients than White patients. It was also larger among patients from lower-income ZIP codes (p < 0.05 for all). Medicaid expansion was associated with an increase in discharge to inpatient rehabilitation (DD 0.6 percentage points; 95% CI, 0.2 to 0.9 percentage points). This increase was larger among patients from the lowest-compared with highest-income ZIP codes (p < 0.05). Medicaid expansion was not associated with changes in in-hospital mortality or readmission or return ED visit rates overall, but was associated with decreased in-hospital mortality among Black patients (DD –0.4 percentage points; 95% CI, –0.8 to –0.1 percentage points).
The Affordable Care Act Medicaid expansion, in its first 4 years, increased insurance coverage and access to rehabilitation among young adult trauma patients. It also reduced the socioeconomic disparity in inpatient rehabilitation access and the disparity in in-hospital mortality between Black and White patients.
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