The Affordable Care Act Medicaid Expansion, Social Disadvantage, and the Practice Location Choices of New General Internists.

Content Provider	Europe PMC
Author	Escarce, José J. Wozniak, Gregory D. Tsipas, Stavros Pane, Joseph D. Ma, Yanlei Brotherton, Sarah E. Yu, Hao
Copyright Year	2022
Abstract	Background:A recent study found that states that expanded Medicaid under the Affordable Care Act (ACA) gained new general internists who were establishing their first practices, whereas nonexpansion states lost them.Objective:The objective of this study was to examine the level of social disadvantage of the areas of expansion states that gained new physicians and the areas of nonexpansion states that lost them.Research Design:We used American Community Survey data to classify commuting zones as high, medium, or low social disadvantage. Using 2009–2019 data from the AMA Physician Masterfile and information on states’ Medicaid expansion status, we estimated conditional logit models to compare where new physicians located during the 6 years following the expansion to where they located during the 5 years preceding the expansion.Subjects:A total of 32,102 new general internists.Results:Compared with preexpansion patterns, new general internists were more likely to locate in expansion states after the expansion, a finding that held for high, medium, and low disadvantage areas. We estimated that, between 2014 and 2019, nonexpansion states lost 371 new general internists (95% confidence interval, 203–540) to expansion states. However, 62.5% of the physicians lost by nonexpansion states were lost from high disadvantage areas even though these areas only accounted for 17.9% of the population of nonexpansion states.Conclusions:States that opted not to expand Medicaid lost new general internists to expansion states. A highly disproportionate share of the physicians lost by nonexpansion states were lost from high disadvantage areas, potentially compromising access for all residents irrespective of insurance coverage.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC8989636&blobtype=pdf
ISSN	00257079
Journal	Medical Care [Med Care]
Volume Number	60
PubMed Central reference number	PMC8989636
Issue Number	5
PubMed reference number	35250020
e-ISSN	15371948
DOI	10.1097/mlr.0000000000001703
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2022-05-01
Access Restriction	Open
Rights License	This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/ Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
Subject Keyword	Affordable Care Act Medicaid expansion health care workforce physician geographical distribution underserved areas
Content Type	Text
Resource Type	Article
Subject	Public Health, Environmental and Occupational Health