Annotated Bibliography 6

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Annotated Bibliography 6 Brielle West Courtemanche, Charles, James Marton, Benjamin Ukert, Aaron Yelowitz, and Daniela Zapata. “The Impact of the Affordable Care Act on Health Care Access and Self‐assessed Health in the Trump Era (2017‐2018).” Health Services Research 55, no. S2 (August 31, 2020): 841–50. https://doi.org/10.1111/1475-6773.13549 . This paper examined the impact of the major components of the Affordable Care Act (ACA) on healthcare access and self-assessed health during the first two years of the ACA’s implementation. Review suggests that the ACA, including Medicaid expansions, increased coverage and access after one to four years following its reform. The paper estimates the causal effects of the ACA during 2017 and 2018, the first two years under the Trump administration; the authors use data from the Behavioral Risk Factor Surveillance System (BRFSS). Results suggest that insurance coverage in states with Medicaid expansion increased by 6.6 percentage points in 2014 to 11.8 percentage points in 2018. In states that did not expand Medicaid, gains in insurance coverage grew from 3.8 percentage points in 2014 to 7.6 percentage points in 2018. Further, it was found that there was no evidence that under the first two years of the Trump presidency to support the debate that ACA coverage would lead to significantly smaller coverage increases compared to 2016. Donohue, Julie M., Evan S. Cole, Cara James, Marian Jarlenski, Jamila Michener, and Eric T. Roberts. “The US Medicaid Program.” JAMA 328, no. 11 (September 20, 2022): 1085. https://doi.org/10.1001/jama.2022.14791 . Since its enactment, Medicaid has become the largest health insurance programs by enrollment in the U.S. and has had a significant impact in financing care for low-income, pregnant women, the elderly, people with disabilities, and minority groups. The paper sought to describe Medicaid eligibility, expenses, and enrollment in the U.S. and examine

payment and delivery systems, reforms, Medicaid expansion, and racial and ethnic disparities in coverage. What was found was that Medicaid covered roughly 80.6 million people in 2022 and accounted for $671.2 billion in healthcare spending in 2020. In states that had adopted Medicaid expansion under the Affordable Care Act (ACA), saw increased coverage, federal revenue, and improved access to healthcare and health outcomes. Disparities in healthcare coverage and access are common in racial and ethnic minority groups; however, roughly 56.4% of Medicaid beneficiaries in 2019 were from these groups. Medicaid covers a significant portion of the U.S. population and thus accounts for a significant amount of health spending and state expenditures. However, the authors argue that further reforms are needed to address the health disparities by racial and ethnic minority groups. While there have been advancements in this area, more must be done. Kelley, A. Taylor, Renuka Tipirneni, and Helen Levy. “Changes in Veterans’ Coverage and Access to Care Following the Affordable Care Act, 2011–2017.” American Journal of Public Health 109, no. 9 (September 1, 2019): 1233–35. https://doi.org/10.2105/ajph.2019.305160 . “Changed in Veteran’s Coverage and Access to Care Following the Affordable Care Act, 2011-2017” evaluates the effects of the Affordable Care Act (ACA) on U.S. veterans’ access to medical care. The paper sought to determine the changes in veterans’ coverage and access to care before and after ACA coverage provisions while comparing changes in states that expanded Medicaid with changes in states that did not expand Medicaid. What was found when comparing Medicaid in expansion states and in non-expansion states was that insurance coverage had significantly improved in both states. Post-2014, cost- related delays in receiving treatment were reduced among non-elderly veterans, when looking at Medicaid expansion, veterans living in expansion states saw greater

improvements in access than veterans living in non-expansion states. Overall, veterans' access to care improved due to the expansion in coverage because of the ACA, and the provisions implemented reduced financial barriers to accessing health care. McRae, Jacquelyn, F. Randy Vogenberg, Silky Beaty, Elizabeth S. Mearns, Štefan Varga, and Laura T. Pizzi. “A Review of US Drug Costs Relevant to Medicare, Medicaid, and Commercial Insurers Post-Affordable Care Act Enactment, 2010–2016.” PharmacoEconomics 35, no. 2 (October 31, 2016): 215–23. https://doi.org/10.1007/s40273-016-0458-0 . “A Review of US Drug Costs Relevant to Medicare, Medicaid, and Commercial Insurers Post-Affordable Care Act Enactment, 2010–2016” is a literature review reviewing U.S. drug costs after the ACA to Medicaid, Medicare, and commercial payors. The review breaks down U.S. drug costs by acquisition costs, reimbursement, and, lastly, ACA reform, and Medicaid drug rebates. Then, it highlights possible factors that could lead to the drug prices seen in the U.S. Briefly discussing value-based drug contracts and payment models, the paper then goes into emerging issues such as consumer out-of- pocket costs, examining the financial impact of high prices, drug shortages, which affect drug prices, and pricing gouging by pharmaceutical companies and there role in high drug prices in the U.S. market. While the ACA did increase health insurance for millions of Americans, this review found that some patients are still at risk for high out-of-pocket costs for specialty drugs as they are on a different tier compared to more common prescription drugs. Mitchell, Alison. “Federal Financing for the State Children’s Health Insurance Program (CHIP).” Congressional Research Service, May 23, 2018. https://congressional-proquest- com.eu1.proxy.openathens.net/congressional/result/congressional/congdocumentview? accountid=12085&groupid=101906&linkId=55f5fcb4-42c3-4ee4-828a- fa14924d3f51&parmId=18AA011BD44&rsId=18AA011227D#137 .

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This report aims to provide an overview of Children’s Health Insurance Program (CHIP) financing. CHIP is a program that provides health coverage to low-income children, and pregnant women in families who are ineligible for Medicaid, but still have no health insurance. While CHIP is financed by both the federal government and the state government, and administered by the state, the federal government sets basic requirements. However, states can design their version of CHIP, as long as it aligns with the federal government's basic framework for the program. As financing comes from the federal government, it is determined using the FMAP formula, which compares the average capita income of each state with the average U.S. per capita income. High reimbursement goes to states with lower incomes and lower reimbursement goes to states with higher incomes. Report describes different aspects of federal CHIP funding, while also looks at recent legislative action that has resulted in federal funding for CHIP through the fiscal year of 2027. Summary For this annotated bibliography, all journal articles were focused on Medicaid, Medicare and its expansions in the form of the State Children’s Health Insurance Program, also known as CHIP, and the Affordable Care Act (ACA). The first article examined the impact of the Affordable Care Act on healthcare access during the first two years of the Trump presidency. What was found was that there was not significant evidence to argue the debate that there would be a decrease in coverage. The second article was a general overview of Medicaid, examining eligibility, expenses, enrollment, payment and delivery systems and disparities in coverage. “Changes in Veterans’ Coverage and Access to Care Following the Affordable Care Act, 2011– 2017” examined veterans' access to care and insurance coverage before and after implementing

the Affordable Care Act. The fourth article was a little different, while it did discuss Medicare and Medicaid, it did so through the lens of drug prices in the U.S. This study focused on reviewing current drug costs post-ACA implementation. Finally, the last article looked at the framework of federal financing of CHIP, an overview. Highlights the intricacies of CHIP being financed by both the state and the federal government.

Annotated Bibliography 6

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