Beschreibung:
<jats:sec><jats:title>Objective</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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 (<jats:styled-content style="fixed-case">ACS</jats:styled-content>) conditions were the unit of primary analysis. The primary outcome variable was access to care measured by preventable hospitalizations caused by an <jats:styled-content style="fixed-case">ACS</jats:styled-content> condition.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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 [<jats:styled-content style="fixed-case">OR</jats:styled-content>] 0.958); however, after adjusting for several covariates, Medicaid expansion states had increased odds of having preventable lupus hospitalizations (<jats:styled-content style="fixed-case">OR</jats:styled-content> 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.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>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.</jats:p></jats:sec>