Brandy J. Lipton

Do Medicaid benefit expansions have teeth? The effect of Medicaid adult dental coverage on the use of dental services and oral health.

This article examines the effect of Medicaid adult dental coverage on use of dental care and dental health outcomes using state-level variation in dental coverage during 2000-2012. Our findings imply that dental coverage is associated with an increase in the likelihood of a recent dental visit, with the size of the effect increasing with Medicaid payment rates to dentists, and a reduction in the likelihood of untreated dental caries. We are among the first to detect an effect of Medicaid coverage on a clinical health outcome other than mortality. These findings may have implications for states expanding Medicaid coverage to adults with incomes of up to 138% of the federal poverty threshold under the Affordable Care Act as most of these states offer an adult dental benefit.

Most Newly Insured People In 2014 Were Long-Term Uninsured

In 2014-after the implementation of most of the Affordable Care Act provisions, including Medicaid expansions in some states and subsidies to purchase Marketplace coverage in all states-adults who had been uninsured for more than three years represented a larger share of the newly insured, compared to adults who had been insured for shorter periods of time.

The effect of health insurance coverage on medical care utilization and health outcomes: Evidence from Medicaid adult vision benefits.

Increasing the proportion of adults that have regular, comprehensive eye exams and reducing visual impairment due to uncorrected refractive error and other common eye health problems are federal health objectives. We examine the effect of vision insurance on eye care utilization and vision health outcomes by taking advantage of quasi-experimental variation in Medicaid coverage of adult vision care. Using a difference-in-difference-in-difference approach, we find that Medicaid beneficiaries with vision coverage are 4.4 percentage points (p<0.01) more likely to have seen an eye doctor in the past year, 5.3 percentage points (p<0.01) less likely to report needing but not purchasing eyeglasses or contacts due to cost, 2.0 percentage points (p<0.05) less likely to report difficulty seeing with usual vision correction, and 1.2 percentage points (p<0.01) less likely to have a functional limitation due to vision.

Medicaid Expansion Coverage Effects Grew In 2015 With Continued Improvements In Coverage Quality

Previous research has demonstrated large gains in insurance coverage associated with the Affordable Care Acts (ACAs) Medicaid expansion in 2014. We used detailed federal survey data through 2015 to analyze more recent changes in coverage for low-income adults after the expansion. We found that the uninsurance rate fell in both expansion and nonexpansion states but that it fell significantly more in expansion states. By 2015 the post-ACA uninsurance rate for low-income adults had fallen by 7.5 percentage points more in expansion than in nonexpansion states, a difference that was similar (about 6.8 percentage points) in adjusted regression models. Private coverage increased in nonexpansion states, but significantly less than Medicaid coverage increased in expansion states. Rates of private coverage did not appear to decline in expansion states. Finally, Medicaid expansion was associated with significantly improved quality of health coverage, as reported by low-income adults.

The Affordable Care Act Appears to Have Narrowed Racial and Ethnic Disparities in Insurance Coverage and Access to Care Among Young Adults

Prior to the Affordable Care Act, one in three young adults aged 19 to 25 years were uninsured, with substantial racial/ethnic disparities in coverage. We analyzed the separate and cumulative changes in racial/ethnic disparities in coverage and access to care among young adults after implementation of the Affordable Care Act’s 2010 dependent coverage provision and 2014 Medicaid and Marketplace expansions. We find that the dependent coverage provision was associated with similar gains across racial/ethnic groups, but the 2014 expansion was associated with larger gains in coverage among Hispanics and Blacks relative to Whites. After the 2014 expansion, coverage increased by 11.0 and 10.1 percentage points among Hispanics and Blacks, respectively, compared with a 5.6 percentage point increase among Whites. The percentage with a usual source of care and a recent doctor’s visit also increased more for Blacks relative to Whites. Increases in coverage were larger in Medicaid expansion compared with nonexpansion states for most racial/ethnic groups.

Changes In Health Status And Care Use After ACA Expansions Among The Insured And Uninsured

Following the Affordable Care Acts insurance expansion provisions in 2014, the average health status and use of health care within coverage groups has likely changed. Medicaid enrollees and the uninsured were both healthier in 2014 than those respective groups were in 2013. By contrast, those with individual private insurance coverage appeared less healthy as a group.

Association between diagnosed diabetes and trouble seeing, National Health Interview Survey, 2011-13.

Approximately 21 million individuals in the US have diagnosed diabetes. Diabetic retinopathy, a progressive condition that can ultimately lead to blindness, affects approximately 29% of adults aged 40 years and older with diabetes. Diabetes is also associated with an increased likelihood of other conditions that may affect vision, such as cataracts and glaucoma. We assessed the association between diagnosed diabetes and selfreported trouble seeing while controlling for other covariates that may affect vision. The present study used 2011–13 data from the National Health Interview Survey (NHIS). The NHIS is a nationally representative sample of US households, with one adult member of each family selected to complete a more in-depth survey. Final 2011–13 sample adult response rates ranged from 61% to 66%. Respondents were asked if they had trouble seeing even when wearing usual vision correction. Possible responses included “yes”, “no”, and “don’t know”, and were used to create a binary variable equal to one for those who did and zero for those who did not report trouble seeing (responses of “don’t know” and refusals [accounting for <0.01% of responses] were considered missing). Those who reported receiving a diabetes diagnosis from a healthcare provider were classified as having diabetes. The sample consisted of adults aged 25 years and older with complete demographic, comorbidity, vision, and diabetes information. Multivariate logistic regression analysis was used to describe the association between diagnosed diabetes and trouble seeing. We first adjusted for age and sex only, successively controlling for select demographic characteristics and diabetes-related comorbidities to investigate the possible reasons for any association. Sampling weights were used to produce nationally representative estimates and standard errors accounted for the complex design of the NHIS. Before adjusting for covariates, approximately 19% of individuals with diagnosed diabetes had trouble seeing compared with approximately 8% of those without diabetes, a significant difference of over 10 percentage points (Table 1). Those with diagnosed diabetes were older, less educated, and more likely to have a history of comorbid conditions, characteristics that Correspondence Brandy J. Lipton, Social and Scientific Systems, 540 Gaither Road, Suite 2000, Rockville, MD 20850, USA. Tel: +1 301 427 1599 Fax: +1 301 427 1277 Email: brandy.lipton@ahrq.hhs.gov