Blair G Darney1,2,3, Frances M Biel1, Maria I Rodriguez1, R Lorie Jacob4, Erika K Cottrell4, Jennifer E DeVoe5. 1. Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR. 2. National Institute of Public Health, Population Research Center (INSP/CISP), Cuernavaca, Morelos, Mexico. 3. OHSU-PSU School of Public Health. 4. OCHIN Inc. 5. Department of Family Medicine, Oregon Health and Science University, Portland, OR.
Abstract
OBJECTIVES: We describe payor for contraceptive visits 2013-2014, before and after Medicaid expansion under the Affordable Care Act (ACA), in a large network of safety-net clinics. We estimate changes in the proportion of uninsured contraceptive visits and the independent associations of the ACA, Title X, and state family planning programs. METHODS: Our sample included 237 safety net clinics in 11 states with a common electronic health record. We identified contraception-related visits among women aged 10-49 years using diagnosis and procedure codes. Our primary outcome was an indicator of an uninsured visit. We also assessed payor type (public/private). We included encounter, clinic, county, and state-level covariates. We used interrupted time series and logistic regression, and calculated multivariable absolute predicted probabilities. RESULTS: We identified 162,666 contraceptive visits in 219 clinics. There was a significant decline in uninsured contraception-related visits in both Medicaid expansion and nonexpansion states, with a slightly greater decline in expansion states (difference-in-difference: -1.29 percentage points; confidence interval: -1.39 to -1.19). The gap in uninsured visits between expansion and nonexpansion states widened after ACA implementation (from 2.17 to 4.1 percentage points). The Title X program continues to fill gaps in insurance in Medicaid expansion states. CONCLUSIONS: Uninsured contraceptive visits at safety net clinics decreased following Medicaid expansion under the ACA in both expansion and nonexpansion states. Overall, levels of uninsured visits are lower in expansion states. Title X continues to play an important role in access to care and coverage. In addition to protecting insurance gains under the ACA, Title X and state programs should continue to be a focus of research and advocacy.
OBJECTIVES: We describe payor for contraceptive visits 2013-2014, before and after Medicaid expansion under the Affordable Care Act (ACA), in a large network of safety-net clinics. We estimate changes in the proportion of uninsured contraceptive visits and the independent associations of the ACA, Title X, and state family planning programs. METHODS: Our sample included 237 safety net clinics in 11 states with a common electronic health record. We identified contraception-related visits among women aged 10-49 years using diagnosis and procedure codes. Our primary outcome was an indicator of an uninsured visit. We also assessed payor type (public/private). We included encounter, clinic, county, and state-level covariates. We used interrupted time series and logistic regression, and calculated multivariable absolute predicted probabilities. RESULTS: We identified 162,666 contraceptive visits in 219 clinics. There was a significant decline in uninsured contraception-related visits in both Medicaid expansion and nonexpansion states, with a slightly greater decline in expansion states (difference-in-difference: -1.29 percentage points; confidence interval: -1.39 to -1.19). The gap in uninsured visits between expansion and nonexpansion states widened after ACA implementation (from 2.17 to 4.1 percentage points). The Title X program continues to fill gaps in insurance in Medicaid expansion states. CONCLUSIONS: Uninsured contraceptive visits at safety net clinics decreased following Medicaid expansion under the ACA in both expansion and nonexpansion states. Overall, levels of uninsured visits are lower in expansion states. Title X continues to play an important role in access to care and coverage. In addition to protecting insurance gains under the ACA, Title X and state programs should continue to be a focus of research and advocacy.
Authors: Maria Isabel Rodriguez; Blair G Darney; Emily Elman; Rachel Linz; Aaron B Caughey; K John McConnell Journal: Contraception Date: 2014-12-27 Impact factor: 3.375
Authors: Heather Angier; Megan Hoopes; Miguel Marino; Nathalie Huguet; Elizabeth A Jacobs; John Heintzman; Heather Holderness; Carlyn M Hood; Jennifer E DeVoe Journal: Ann Fam Med Date: 2017-09 Impact factor: 5.166
Authors: Michelle H Moniz; Matthias A Kirch; Erica Solway; Susan D Goold; John Z Ayanian; Edith C Kieffer; Sarah J Clark; Renuka Tipirneni; Jeffrey T Kullgren; Tammy Chang Journal: JAMA Netw Open Date: 2018-08-03
Authors: Blair G Darney; R Lorie Jacob; Megan Hoopes; Maria I Rodriguez; Brigit Hatch; Miguel Marino; Anna Templeton; Jee Oakley; Erika K Cottrell Journal: JAMA Netw Open Date: 2020-06-01