Effects of the ACA Medicaid expansions on access and health by nurse practitioner scope of practice laws |
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| Institution: | 1. Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA;2. Department of Health Management and Policy, Departments of Economics and Preventive & Community Dentistry, and Public Policy Center, University of Iowa, Iowa City, IA;3. National Bureau of Economics Research, Cambridge, MA;1. Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel;2. Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA;3. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA;1. School of Nursing, School of Public Health, University of Michigan, Ann Arbor, MI;2. College of Nursing, University of Rhode Island, Kingston, RI;3. Connell School of Nursing, Boston College, Boston, MA;4. College of Nursing, Montana State University, Bozeman, MT;1. School of Nursing, School of Public Health, University of Michigan, Ann Arbor, MI;2. College of Nursing, University of Rhode Island, Kingston, RI,;3. College of Nursing, Montana State University, Bozeman, MT;1. Duke University School of Nursing, Durham, NC;2. Abbott Northwestern Hospital, Minneapolis, MN;3. Allina Health, Minneapolis, MN;4. University of Minnesota School of Nursing, Minneapolis, MN |
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| Abstract: | BackgroundThe Affordable Care Act (ACA) Medicaid expansions increased demand for care whereas the Scope of Practice (SOP) laws for nurse procatitioners affect the supply of primary care providers. It is important to udnerstand the interaction of the demand and supply side policies on measures of access to care and health status.PurposeTo examine whether effects of the Affordable Care Act (ACA) Medicaid expansions on access to care and health status are moderated by state scope of practice (SOP) laws for nurse practitioners.MethodsUsing data from the 2011 to 2019 Behavioral Risk Factor Surveillance System, the study used a difference-in-differences design that compared outcome changes between expansion and non-expansion states and evaluated whether these changes differed by state SOP laws.DiscussionFollowing Medicaid expansion, forgoing a needed doctor's visit due to cost declined more in expansion states with full SOP laws than states with reduced SOP laws by 3.0 percentage-points in years 1 to 3 after the expansion (p < .05). Furthermore, completing a routine checkup with a doctor increased more in expansion states with full SOP laws by 3.2 percentage-points in 4 to 6 years (p < .05).ConclusionThe ACA Medicaid expansions were associated with larger gains in certain access measures in states with full SOP laws. |
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