Are abortions covered by Medicaid?
Judgment on cancer treatment in the community after insurance extensions
The morbidity and mortality of cancer is greatly reduced by screening and prevention, but uninsured patients receive these evidence-based patients much less often than insured patients as recommended. In addition, uninsured cancer survivors receive fewer primary and preventive services than those with health insurance. Thus, it is believed that the Affordable Care Act (ACA) Medicaid enhancements could greatly improve access to essentials in cancer prevention and screening services for previously uninsured patients and facilitate better care for cancer survivors who take out health insurance. In 2012, the United States (US) Supreme Court ruled that states are not required by law to implement ACA Medicaid extensions that create a unique natural experiment to test this hypothesis. As of April 1, 2015, 30 states and the District of Columbia had expanded and 20 states had not. This resulted in a 26% increase in Medicaid enrollment in expanding states versus 8% in non-expanding states. Previous Medicaid expansions in a state resulted in increased health service utilization and improved health outcomes after the expansion. For example, in Oregon, the screening rate for cervical cancer was 18 to 19% higher in women who received Medicaid in 2008. compared to those who were not insured. So far, no country-specific assessments. Extensions had simultaneous control states for comparison (non-extension states). Further, little is known about how the Medicaid expansion will affect the delivery of recommended primary and preventive care services for cancer survivors, known as & quot; survival care & quot; are designated.
The researchers propose using ACA Medicaid's natural expansion experiment to examine the impact of the state-level Medicaid expansion on cancer screening and prevention rates ("cancer prevention") and survival care. Many Patients Likely To Be Covered By ACA Medicaid Extensions Are Treated In Community Health Centers (CHCs), The Nation Of Our Country, In Primary Care Safety Net For The Health Care System; Therefore, the electronic health record (EHR) is used for the proposed analyzes. Data from the ADVANCE network for clinical data research (CDRN) from CHCs (ADVANCE is one of 11 CDRNs in the national PCORnet data network). The ADVANCE CDRN contains patient-level data from 476 CHCs in 13 Medicaid expansion states (n = 576,711 patients) and 242 CHCs in 8 non-expansion states (n = 361,421 patients). With this nationally unique data resource, we can measure outcomes in states of expansion and non-expansion that shed light on the effects of an increase in Medicaid opportunities for cancer prevention rates and for caring for survivors in the safety net. Investigators will also assess whether the differences in the delivery of this care are reduced. Our specific goals for this study, entitled "Assessing Cancer Treatment in the Community After Insurance" Extensions (ACCESS), & quot; are to:
OBJECTIVE 1. Compare the prevention and screening of cancer before and after receiving it in at-risk CHC patients in Medicaid expansion versus non-expansion.
Hypothesis 1a: Cancer prevention and screening will increase significantly in CHC patients in states of expansion compared to those in states of non-expansion.
Hypothesis 1b: Racial / ethnic differences in cancer prevention and care will exist significantly reduced in states of expansion versus no change in states of non-expansion.
Objective 2. Compare pre-follow-up insurance status, visits, and routine maintenance, recommended primary insurance, and care for cancer survivors observed in CHCs in expansion versus non-expansion conditions.
Hypothesis 2a: A higher percentage of uninsured cancer survivors had insurance coverage in expansion states compared to those in non-expansion states.
Hypothesis 2b: Cancer survivors who are CHC patients in states of expansion have a significant increase in visits, visits to Medicaid, and care for survivors compared to no change in patients in non-expanding states.
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