Early Impact of the Patient Protection and Affordable Care Act on Delivery of Children's Surgical Care

Clin Pediatr (Phila). 2019 Apr;58(4):453-460. doi: 10.1177/0009922818825156. Epub 2019 Jan 22.


The impact of the Patient Protection and Affordable Care Act (PPACA) on children's access to surgical care is not well-defined. Our objective was to describe the early impact of PPACA on children's surgical care before and after Medicaid expansion in 2014. We compared pediatric and young adult surgical outcomes in 2013 and 2014 in Medicaid expansion and nonexpansion states; young adults were included as a control group. From 4 states, 1 597 708 encounters met all inclusion criteria. Comparing expansion to nonexpansion states, modest increases were noted in elective instead of urgent/emergent admissions; in ambulatory instead of inpatient surgeries; in inpatient length of stays; in discharges to home instead of other inpatient care facilities; and in charges for inpatient admissions. A modest decrease of -1.1% was noted in ambulatory admission charges. Overall, we conclude that Medicaid expansion likely increased children's access to surgical care, resulting in improved delivery and slightly reduced charges.

Keywords: Medicaid expansion; health care delivery; health policy; pediatrics; surgery.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child Health / legislation & jurisprudence*
  • Child, Preschool
  • Delivery of Health Care / legislation & jurisprudence*
  • Female
  • Health Services Accessibility / legislation & jurisprudence*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Medicaid / legislation & jurisprudence
  • Patient Protection and Affordable Care Act*
  • Surgical Procedures, Operative*
  • United States
  • Young Adult