ArticleJournal of the American College of Surgeons2021
Association of the Affordable Care Act Medicaid Expansion with Trauma Outcomes and Access to Rehabilitation among Young Adults: Findings Overall, by Race and Ethnicity, and Community Income Level.
Article in Journal of the American College of Surgeons, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 25 citations in OpenAlex.
- Health insurance payor type and care deviations in patients with trauma with lower extremity fractures.Trauma surgery & acute care open · 2026Article
- Decrease in Pediatric Anterior Cruciate Ligament Injury-related Care Disparities for Medicaid Patients From 2015 to 2020.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2025Article
- Innovative approaches to equity research in trauma: current work and aspirations from the Summit on the Advancement of Focused Equity Research in Trauma (SAFER-Trauma).Trauma surgery & acute care open · 2025Review
- Trauma care disparities: is equity the key? Output from SAFER-Trauma.Trauma surgery & acute care open · 2025Review
- Pediatric Trauma Recidivism: A Statewide Risk Factor Analysis of the Maryland Health Services Cost Review Commission (HSCRC).Journal of pediatric surgery · 2024Article
- Race and Ethnicity Influences Outcomes of Adult Burn Patients.Journal of burn care & research : official publication of the American Burn Association · 2023Article
- Socioeconomic Factors and Pediatric Injury.Current trauma reports · 2023Review
- Impact of Medicaid expansion on young adult firearm and motor vehicle crash trauma patients.Surgery open science · 2022Article
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Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundLow-income young adults disproportionately experience traumatic injury and poor trauma outcomes. This study aimed to evaluate the effects of the Affordable Care Act's Medicaid expansion, in its first 4 years, on trauma care and outcomes in young adults, overall and by race, ethnicity, and ZIP code-level median income. STUDY
designStatewide hospital discharge data from 5 states that did and 5 states that did not implement Medicaid expansion were used to perform difference-in-difference (DD) analyses. Changes in insurance coverage and outcomes from before (2011-2013) to after (2014-2017) Medicaid expansion and open enrollment were examined in trauma patients aged 19 to 44 years.
resultsMedicaid expansion was associated with a decrease in the percentage of uninsured patients (DD -16.5 percentage points; 95% CI, -17.1 to -15.9 percentage points). This decrease was larger among Black patients but smaller among Hispanic patients than White patients. It was also larger among patients from lower-income ZIP codes (p < 0.05 for all). Medicaid expansion was associated with an increase in discharge to inpatient rehabilitation (DD 0.6 percentage points; 95% CI, 0.2 to 0.9 percentage points). This increase was larger among patients from the lowest-compared with highest-income ZIP codes (p < 0.05). Medicaid expansion was not associated with changes in in-hospital mortality or readmission or return ED visit rates overall, but was associated with decreased in-hospital mortality among Black patients (DD -0.4 percentage points; 95% CI, -0.8 to -0.1 percentage points).
conclusionsThe Affordable Care Act Medicaid expansion, in its first 4 years, increased insurance coverage and access to rehabilitation among young adult trauma patients. It also reduced the socioeconomic disparity in inpatient rehabilitation access and the disparity in in-hospital mortality between Black and White patients.
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