Uriel Kim
Published: 2020
Total Pages:
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A chief focus of The Patient Protection and Affordable Care Act (ACA) was addressing income-based disparities in access to care since uninsured individuals were more likely to be low-income prior to the ACA. The main vehicles for improving access are Medicaid Expansion and insurance "Marketplaces" (also known as the, "Health Insurance Exchanges - HIEs", or the "Exchanges"), which are platforms to purchase private insurance that meet essential benefit requirements. The impact that the ACA has had in reducing the number of low-income, uninsured individuals is incontrovertible, but less is known about how these gains in insurance coverage have translated to improvements in population health. Therefore, Aim 1 investigates the extent to which Medicaid Expansion and the Exchanges have improved health care access in low-income Ohioans by evaluating changes to self-reported measures of health care access. Aims 2 and 3 evaluate whether the improvements in healthcare access suggested in Aim 1 have translated to meaningful improvements in stage at diagnosis in four screening-amenable cancers (breast, cervical, colorectal, and lung cancer). Aim 2 focuses on the low-income, Medicaid-eligible Ohioans, while Aim 3 focuses on low-income privately insured Ohioans, including those with Marketplace insurance. During this time of rapid health systems evolution, these studies, which provide timely insight on the impact of the Marketplaces and Medicaid Expansion on both healthcare access and disease-specific outcomes, can help inform future policy efforts to improve population health.