Impact of the Affordable Care Act Medicaid Expansion on Access to Care and Hospitalization Charges for Lupus Patients

Arthritis Care Res (Hoboken). 2020 Feb;72(2):208-215. doi: 10.1002/acr.24080.


Objective: To examine the impact of the Affordable Care Act on preventable hospitalizations and associated charges for patients living with systemic lupus erythematosus, before and after Medicaid expansion.

Methods: A retrospective, quasi-experimental study, using an interrupted time series research design, was conducted to analyze data for 8 states from the Healthcare Cost and Utilization Project state inpatient databases. Lupus hospitalizations with a principal diagnosis of predetermined ambulatory-care sensitive (ACS) conditions were the unit of primary analysis. The primary outcome variable was access to care measured by preventable hospitalizations caused by an ACS condition.

Results: There were 204,150 lupus hospitalizations in the final analysis, with the majority (53.5%) of lupus hospitalizations in states that did not expand Medicaid. In unadjusted analysis, Medicaid expansion states had significantly lower odds of having preventable lupus hospitalizations (odds ratio [OR] 0.958); however, after adjusting for several covariates, Medicaid expansion states had increased odds of having preventable lupus hospitalizations (OR 1.302). Adjusted analysis showed that those individuals with increased age, public insurance (Medicare or Medicaid), no health insurance, rural residence, or low income had significantly higher odds of having a preventable lupus hospitalization. States that expanded Medicaid had $523 significantly more charges than states that did not expand Medicaid. Older age and rural residence were associated with significantly higher charges.

Conclusion: Our findings suggest that while Medicaid expansion increased health insurance coverage, it did not address other issues related to access to care that could reduce the number of preventable hospitalizations.

MeSH terms

  • Adult
  • Female
  • Health Services Accessibility / economics
  • Health Services Accessibility / trends*
  • Hospital Charges / trends*
  • Hospitalization / economics
  • Hospitalization / trends*
  • Humans
  • Interrupted Time Series Analysis / economics
  • Interrupted Time Series Analysis / trends
  • Lupus Erythematosus, Systemic / economics
  • Lupus Erythematosus, Systemic / epidemiology*
  • Lupus Erythematosus, Systemic / therapy
  • Male
  • Medicaid / economics
  • Medicaid / trends*
  • Middle Aged
  • Patient Protection and Affordable Care Act / economics
  • Patient Protection and Affordable Care Act / trends*
  • Retrospective Studies
  • United States / epidemiology
  • Young Adult