Effect of the Affordable Care Act on emergency and primary care


Justin Trogdon (chair), Sally Stearns, Stacie Dusetzina, Lindsay Sabik, Timothy Platts-Mills


aim 1

This aim uses restricted data from the 2012 National Health Interview Survey and 2013 and 2014 Medical Expenditure Panel Survey to assess the relationship between persistence of uninsurance prior to gaining coverage on substitution between emergency department and primary care visits. It uses the first year of the Marketplace and Medicaid expansion to provide a large set of individuals transitioning into coverage, also exploring how utilization responses vary by cost sharing burden.

aim 2

This aim uses emergency department visit discharge data from the Healthcare Cost and Utilization Project across seven states from 2008 to 2016 to assess whether there are delayed effects of coverage expansion on emergency department use. Two algorithms are used to identify preventable and non-emergent visits that are more likely to be substitutable to a primary care, retail clinic, and/or urgent care setting, exploring the presence of lagged effects and spatial correlation at the county level within states.

aim 3

This aim uses commercial health insurance claims data from IBM Health® MarketScan® to identify whether high deductible plan enrollment is associated with lower use of preventive services for which the Affordable Care Act eliminated cost sharing in late 2010. It uses a cohort of adults who are continuously insured in the same plan type to assess whether there is differential response to the price shock, employing a semi-parametric difference-in-differences estimator to relax the parallel trends assumption.