Article Figures & Data
Tables
- Table 1.
Prevalence of Pre-existing Conditions and Adjusted Comparisons, Among a Cohort of Established CHC Patients Pre- and Post-Implementation of the Affordable Care Act (ACA) Insurance Expansions in 2014, by Insurance Type and Race/Ethnicity
N Pre-ACA, n (%) Post-ACA, n (%) Adjusted Absolute Prevalence Difference, Post vs Pre-ACA (95% CI) Insurance type Gained Medicaid 50,839 31,454 (61.9) 40,008 (78.7) +16.8 (16.5, 17.2) Gained Private 27,220 14,080 (51.7) 18,987 (69.8) +18.0 (17.6, 18.5) Race/ethnicity Non-Hispanic White 29,764 20,491 (68.8) 25,179 (84.6) +15.8 (15.4, 16.2) Hispanic 30,296 15,108 (49.9) 20,626 (68.1) +18.3 (17.8, 18.7) Non-Hispanic Black 13,090 7413 (56.6) 9827 (75.1) +18.9 (18.2, 19.6) CHC, community health center; CI, confidence interval.
Data from 386 community health centers in 19 states (AK, CA, FL, HI, KS, MD, MN, MO, MT, NC, NM, NV, OH, OR, RI, TX, WA, WI). The retrospective cohort of established patients included those who were uninsured at their last visit pre-ACA (2012 to 2013) and gained insurance coverage post-ACA (2014 to 2015). Conditions identified by ICD 9/10 codes in patients' problem lists or encounter diagnoses based on the Henry J Kaiser Family Foundation list of declinable conditions. We computed within-race/ethnicity and insurance type-group prevalence differences of having at least one pre-existing condition post- vs pre-ACA. Adjusted estimates obtained from generalized estimating equation models specifying a Gaussian distribution, identity link function, an independent working correlation matrix with robust standard errors and adjusted for sex, age, federal poverty level, number of visits, race-ethnicity (insurance type models), post-ACA insurance type (racial/ethnic models), state Medicaid expansion status, and health system. Standard errors were clustered by patient nested within their primary clinic to account for temporal correlation of observations within patients over the ACA periods and intracluster correlation of patients within clinics. Pre-post prevalence differences were significant (P < .001) for all comparisons.
- Table 2.
Prevalence of Top 5 Conditions Pre- and Post-ACA, Among a Cohort of Established Community Health Center Patients Pre- and Post-Implementation of the Affordable Care Act (ACA) Insurance Expansions in 2014, by Insurance Type
Gained Medicaid (N = 50,839) Gained Private (N = 27,220) Pre, n (%) Post, n (%) Pre, n (%) Post, n (%) Alcohol and drug abuse 6,005 (11.8) 10,067 (19.8) 1,087 (4.0) 2,084 (7.7) Asthma and COPD 7,452 (14.7) 10,679 (21.0) 2,865 (10.5) 4,141 (15.2) Diabetes 7,163 (14.1) 8,826 (17.4) 3,982 (14.6) 4,834 (17.8) Mental health disorders 17,077 (33.6) 23,199 (45.6) 5,899 (21.7) 8,292 (30.5) Obesity 8,523 (16.8) 12,972 (25.5) 4,050 (14.9) 6,240 (22.9) COPD, chronic obstructive pulmonary disease, and emphysema.
Data from 386 community health centers in 19 states (AK, CA, FL, HI, KS, MD, MN, MO, MT, NC, NM, NV, OH, OR, RI, TX, WA, WI). The retrospective cohort of established patients included those who were uninsured at their last visit pre-ACA (2012 to 2013) and gained insurance coverage post-ACA (2014 to 2015). Conditions identified by ICD 9/10 codes in patients' problem lists or encounter diagnoses based on the Henry J Kaiser Family Foundation list of declinable conditions.
- Table 3.
Prevalence of Top 5 Conditions Pre- and Post-ACA, Among a Cohort of Established Community Health Center Patients Pre- and Post-Implementation of the Affordable Care Act (ACA) Insurance Expansions in 2014, by Race/Ethnicity
Non-Hispanic White (N = 29,764) Hispanic (N = 30,296) Non-Hispanic Black (N = 13,090) Pre, n (%) Post, n (%) Pre, n (%) Post, n (%) Pre, n (%) Post, n (%) Alcohol and drug abuse 4,576 (15.4) 7,645 (25.7) 1,025 (3.4) 1,881 (6.2) 1,111 (8.5) 1,973 (15.1) Asthma, COPD 5,561 (18.7) 7,960 (26.7) 2,518 (8.3) 3,697 (12.2) 1,653 (12.6) 2,314 (17.7) Diabetes 3,433 (11.5) 4,212 (14.2) 4,661 (15.4) 5,680 (18.7) 2,388 (18.2) 2,933 (22.4) Mental health disorders 12,807 (43.0) 16,666 (56.0) 6,657 (22.0) 9,612 (31.7) 2,380 (18.2) 3,619 (27.6) Obesity 4,743 (15.9) 7,186 (24.1) 4,850 (16.0) 7,391 (24.4) 2,480 (18.9) 3,820 (29.2) COPD, chronic obstructive pulmonary disease, & emphysema.
Data from 386 community health centers in 19 states (AK, CA, FL, HI, KS, MD, MN, MO, MT, NC, NM, NV, OH, OR, RI, TX, WA, WI). The retrospective cohort of established patients included those who were uninsured at their last visit pre-ACA (2012 to 2013) and gained insurance coverage post-ACA (2014 to 2015). Conditions identified by ICD 9/10 codes in patients' problem lists or encounter diagnoses based on the Henry J Kaiser Family Foundation list of declinable conditions.
- Appendix Table 1.
Prevalence of Pre-existing Conditions and Adjusted Comparisons, Among a Cohort of Established Community Health Center Patients Pre- and Post-Implementation of the Affordable Care Act (ACA) Insurance Expansions in 2014, by Insurance Type, Race/Ethnicity, and Medicaid Expansion State Status
Medicaid Expansion State ≤1 Condition Non-Expansion State ≥1 Condition N Pre-ACA, n (%) Post-ACA, n (%) Adjusted Absolute Prevalence Difference, Post vs Pre-ACA (95% CI) N Pre-ACA, n (%) Post-ACA, n (%) Adjusted Absolute Prevalence Difference, Post vs Pre-ACA (95% CI) Insurance type Gained Medicaid 39,520 25,513 (64.6) 32,034 (81.1) +16.5 (16.2, 16.9) 11,319 5,941 (52.5) 7,974 (70.4) +17.9 (17.3, 18.7) Gained Private 11,187 5,841 (52.2) 7,717 (69.0) +16.8 (16.1, 17.5) 16,033 8,239 (51.4) 11,270 (70.3) +18.9 (18.3, 19.5) Race/Ethnicity Non-Hispanic White 22,835 16,135 (70.7) 19,615 (85.9) +15.3 (14.8, 15.7) 6,929 4,356 (62.9) 5,564 (80.3) +17.4 (16.5, 18.3) Hispanic 19,512 10,479 (53.7) 13,967 (71.6) +17.9 (17.4, 18.4) 10,784 4,629 (42.9) 6,659 (61.7) +18.8 (18.1, 19.6) Non-Hispanic Black 4,787 2,789 (58.3) 3,614 (75.5) +17.2 (16.2, 18.3) 8,303 4,624 (55.7) 6,213 (74.8) +19.1 (18.3, 20.0) CI, confidence interval.
Data from 386 community health centers in 19 states (11 expansion, 8 non-expansion). Expansion states include: CA, HI, MD, MN, NM, NV, OH, OR, RI, WI, WA; Non-Expansion states include: AK, FL, IN, KS, MO, MT, NC, TX. The retrospective cohort of established patients included those who were uninsured at their last visit pre-ACA (2012 to 2013) and gained insurance coverage post-ACA (2014 to 2015).
Conditions identified by ICD 9/10 codes in patients' problem lists or encounter diagnoses based on the Henry J Kaiser Family Foundation list of declinable conditions. We computed within-race/ethnicity and insurance type–group prevalence differences of having at least one pre-existing condition post- vs pre-ACA. Adjusted estimates obtained from generalized estimating equation models specifying a Gaussian distribution, identity link function, an independent working correlation matrix with robust standard errors and adjusted for sex, age, federal poverty level, number of visits, race-ethnicity (insurance type models), post-ACA insurance type (racial/ethnic models), state Medicaid expansion status, and health system. Standard errors were clustered by patient nested within their primary clinic to account for temporal correlation of observations within patients over the ACA periods and intracluster correlation of patients within clinics. Pre-post prevalence differences were significant (P < .001) for all comparisons. Sensitivity analysis excluding WI did not result in any substantial differences in point estimates or statistical significance.
- Appendix Table 2.
Prevalence of Top 5 Conditions Pre- and Post-ACA, Among a Cohort of Established CHC Patients Pre- and Post-Implementation of the Affordable Care Act (ACA) Insurance Expansions in 2014, by Insurance Type and Medicaid Expansion State Status
Expansion States Gained Medicaid (N = 39,520) Gained Private (N = 11,187) Pre, n (%) Post, n (%) Pre, n (%) Post, n (%) Alcohol and drug abuse 5,193 (13.1) 8,515 (21.5) 490 (4.4) 876 (7.8) Asthma, COPD 6,131 (15.5) 8,727 (22.1) 1,368 (12.2) 1,909 (17.1) Diabetes 5,669 (14.3) 6,962 (17.6) 1,350 (12.1) 1,617 (14.5) Mental health disorders 14,537 (36.8) 19,293 (48.8) 2,854 (25.5) 3,827 (34.2) Obesity 6,852 (17.3) 10,260 (26.0) 1,594 (14.2) 2,363 (21.1) Non-expansion States Gained Medicaid (N = 11,319) Gained Private (N = 16,033) Pre, n (%) Post, n (%) Pre, n (%) Post, n (%) Alcohol and drug abuse 812 (7.2) 1,552 (13.7) 597 (3.7) 1,208 (7.5) Asthma, COPD 1,321 (11.7) 1,952 (17.2) 1,497 (9.3) 2,232 (13.9) Diabetes 1,494 (13.2) 1,864 (16.5) 2,632 (16.4) 3,217 (20.1) Mental health disorders 2,540 (22.4) 3,906 (34.5) 3,045 (19.0) 4,465 (27.8) Obesity 1,671 (14.8) 2,712 (24.0) 2,456 (15.3) 3,877 (24.2) COPD, chronic obstructive pulmonary disease, & emphysema; CHC, community health center.
Data from 386 community health centers in 19 states (11 expansion, 8 non-expansion). Expansion states include: CA, HI, MD, MN, NM, NV, OH, OR, RI, WI, WA; Non-Expansion states include: AK, FL, IN, KS, MO, MT, NC, TX. The retrospective cohort of established patients included those who were uninsured at their last visit pre-ACA (2012 to 2013) and gained insurance coverage post-ACA (2014 to 2015). Conditions identified by ICD 9/10 codes in patients' problem lists or encounter diagnoses based on the Henry J Kaiser Family Foundation list of declinable conditions.
- Appendix Table 3.
Prevalence of Top 5 Conditions Pre- and Post-ACA, Among a Cohort of Established CHC Patients Pre- and Post-Implementation of the Affordable Care Act (ACA) Insurance Expansions in 2014, by Race/Ethnicity and Medicaid Expansion State Status
Expansion States Non-Hispanic White (N = 22,835) Hispanic (N = 19,512) Non-Hispanic Black (N = 4,787) Pre, n (%) Post, n (%) Pre, n (%) Post, n (%) Pre, n (%) Post, n (%) Alcohol and drug abuse 3,927 (17.2) 6,449 (28.2) 765 (3.9) 1,336 (6.8) 672 (14.0) 1,060 (22.1) Asthma, COPD 4,489 (19.7) 6,395 (28.0) 1,797 (9.2) 2,558 (13.1) 752 (15.7) 1,018 (21.3) Diabetes 2,515 (11.0) 3,112 (13.6) 3,238 (16.6) 3,929 (20.1) 782 (16.3) 941 (19.7) Mental health disorders 10,372 (45.4) 13,336 (58.4) 4,918 (25.2) 6,897 (35.3) 1,145 (23.9) 1,586 (33.1) Obesity 3,787 (16.6) 5,632 (24.7) 3,482 (17.8) 5,189 (26.6) 785 (16.4) 1,185 (24.8) Non-expansion States Non-Hispanic White (N = 6,929) Hispanic (N = 10,784) Non-Hispanic Black (N = 8,303) Pre, n (%) Post, n (%) Pre, n (%) Post, n (%) Pre, n (%) Post, n (%) Alcohol & drug abuse 649 (9.4) 1,196 (17.3) 260 (2.4) 545 (5.1) 439 (5.3) 913 (11.0) Asthma, COPD 1,072 (15.5) 1,565 (22.6) 721 (6.7) 1,139 (10.6) 901 (10.9) 1,296 (15.6) Diabetes 918 (13.2) 1,100 (15.9) 1,423 (13.2) 1,751 (16.2) 1,606 (19.3) 1,992 (24.0) Mental health disorders 2,435 (35.1) 3,330 (48.1) 1,739 (16.1) 2,715 (25.2) 1,235 (14.9) 2,033 (24.5) Obesity 956 (13.8) 1,554 (22.4) 1,368 (12.7) 2,202 (20.4) 1,695 (20.4) 2,635 (31.7) COPD, chronic obstructive pulmonary disease, & emphysema, CHC, community health center.
Data from 386 community health centers in 19 states (11 expansion, 8 non-expansion). Expansion states include CA, HI, MD, MN, NM, NV, OH, OR, RI, WI, WA; Non-expansion states include AK, FL, IN, KS, MO, MT, NC, TX. The retrospective cohort of established patients included those who were uninsured at their last visit pre-ACA (2012 to 2013) and gained insurance coverage post-ACA (2014 to 2015). Conditions identified by ICD 9/10 codes in patients' problem lists or encounter diagnoses based on the Henry J Kaiser Family Foundation list of declinable conditions.