The impact of the Affordable Care Act's medicaid expansion on patients admitted for burns: An analysis of national data

Introduction: The first states began implementing the Medicaid expansion provisions of the Patient Protection and Affordable Care Act (ACA) in 2014. Studies have yet to address its impact on burn patients.Methods: Burn patients in geographic regions that expanded Medicaid coverage were compared to patients in regions that did not expand Medicaid before and after im-plementation of the ACA using bivariate statistics and a difference-in-differences model. A multivariable logistic regression was used to identify factors associated with having Medicaid insurance. The primary outcome of this study was the rate of Medicaid in-surance.Results: Of 25,331 discharges, we found greater increases in Medicaid coverage after the ACA in the Medicaid expander regions (23.4-40.2%) compared to the non-expander regions (18.5-20.1%). The difference-in-differences estimate between the expander and non -ex-pander regions was 0.15 (95% CI: 0.11-0.18, p < 0.001). Patients admitted in expander re-gions were more likely to be insured by Medicaid (OR 1.57 [95%CI 1.21-2.05]), as were patients of Black race (OR 1.25 [95%CI 1.19-1.32), Hispanic ethnicity (OR 1.29 [95%CI 1.14-1.46]), and female sex (OR 1.59 [95%CI 1.11-2.27]). We also found a significant inter-action between time period (pre-ACA/post-ACA) and expander region location (OR 2.10 [95%CI 1.67-2.62]).Conclusions: The Medicaid expansion provision of the ACA led to increased Medicaid cov-erage among burn patients which was significantly higher in areas with widespread im-plementation of the expansion.(c) 2021 Elsevier Ltd and ISBI. All rights reserved.