The Affordable Care Act: A success?

• Published in: The American journal of surgery Vol. 222; no. 2; pp. 254 - 255
• Main Authors: Williams, Jennifer L., Shaffer, Virginia O.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2021; Elsevier Limited
• Subjects: Anorectal; Colon; Cost analysis; Expansion; Government programs; Health care access; Health care policy; Medicaid; Patient Protection & Affordable Care Act 2010-US; Patients; Rectum; Regression models; Surgeons; Surgery; Surgical outcomes; Trauma; Uninsured people
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2021.02.001

In their study, Tong et al. aimed to specifically investigate the impact of Medicaid expansion (ME) on patient access to high volume colon and rectal surgeons by comparing New York (NY), an ME expansion state, to Florida (FL), a non-expansion state before and after implementation of ME using a difference-in-difference analysis (DID) mixed effects logistic regression model.3 The authors found that after ME, Medicaid enrollment significantly increased from 9.6% to 13.9% in NY and decreased from 14.7% to 12.4% in FL. [...]previous studies addressing the impact of high-volume surgeons on colon and rectal surgical outcomes have largely focused on oncologic outcomes.6–9 We commend the authors on including not only colon and rectal resections and malignant surgical indications but also anorectal procedures and urgent operations. Liu et al. found in their recent paper that trauma patients at a high volume trauma center in California were much less likely to endure catastrophic healthcare costs after implementation of ACA.10 In the authors analysis, this improvement is largely attributed to ME, but no non-ME state data for comparison is available.