For over 30 years, AcademyHealth's Annual Research Meeting (ARM) has been the premier forum for health services research, where attendees gather to discuss the health policy and health system implications of research findings, sharpen research methods, and network with colleagues from around the world. This year’s meeting in Boston was the largest one yet with more than 2,900 attendees and included 150 sessions with more than 700 speakers and nearly 1,500 posters.
In this post-ARM series, blog posts will summarize key takeaways from sessions on four hot topics:
- Data and methods: Dealing with increased volume, variety and velocity of data
- The Affordable Care Act: Evaluating the latest in health care reform
- Translation and dissemination: Moving evidence into action
- Race, ethnicity and health
This is the second post:
While provisions of the Affordable Care Act (ACA) began taking place in 2010, some of the most significant aspects of the law have taken effect in the last two years. Recently several in the health services research community have shared thoughts evaluating the ACA. Even President Obama has weighed in. This year’s Annual Research Meeting (ARM) was no different, with several sessions including late-breaking research on topics including coverage, access, quality and cost of care in a post-ACA world.
These late-breaking abstracts examined capacity across a variety of settings and patient populations. Daniel Polsky presented research showing increased access to primary care and Megan Cole presented on improved quality in community health centers. Other papers drilled down to capacity for specific areas of care, such as dental coverage. Amber Willink’s research found that less than half of all Medicare beneficiaries had any dental coverage and Cameron Kaplan’s paper found that ACA tobacco penalties lead to lying and under-enrollment amongst this population. Caitlin Crowley presented research on the health center workforce that found that 95 percent of health centers have at least one clinical vacancy. Questions from attendees focused on how access has changed over time and how differences in service type and location might affect usage and volume.
This session highlighted key findings from late-breaking research on public and private health insurance expansions under the ACA. Research presented by John Graves revealed new dynamics of U.S. health insurance. Benjamin Sommers presented research comparing three states’ (Arkansas, Texas and Kentucky) changes in utilization and health. Overall, researchers found positive downstream effects after expansion, whether via Medicaid or a private option as was the case in Arkansas. Affordability, preventative care and self-reported health outcomes all increased while reliance on emergency department care decreased. Joseph Thompson presented findings on Arkansas’ private option showing a clear benefit between Arkansas and neighbor states without expansion. Stacey McMorrow presented a study looking at the ACA’s effect on employee-sponsored and private insurance found that coverage expansions may have reduced churn between public coverage and uninsured status among low-income adults. Chima Ndumele presented results from a study showing no Medicaid quality erosion based on capacity constraints caused by expansion. Comments and questions from the audience focused on opportunities for further research looking at affordability and cost-sharing subsidies effects as well as comparisons with non-managed care plans.
Research presented in this session examined which particular parts of the ACA have had a positive benefit on coverage and where challenges remain. While there are several incentives to encourage people to sign up for health insurance, research presented by Benjamin Sommers found that 2014 coverage gains were more sensitive to the percent subsidy than the premium dollar amount, and the mandate penalty had little effect. Other research looked at some adverse impacts of other provisions of the ACA such as Erin Trish’s data on small businesses self-insuring to avoid community rated premiums and Lisa Dubay’s presentation on the “family glitch,” which prevents some families from receiving marketplace tax credits because one adult has access to affordable work-only employer coverage. Questions from attendees focused on Kristin Kan’s research findings about a lack of access to pediatric subspecialty care and Lucas Higuera’s projections that the proposed Cadillac tax for employers to pay on high-cost health insurance plans would result in employers substituting increases in health insurance benefits with increases in wages.
Research in this session looked at how competing coverage plans are impacting individuals’ access to care, quality of care, and health outcomes. One study, presented by Sandra Decker, looking at the impact of Medicaid expansion on access to care and health found significant gains in insurance coverage, primary care visits, and specialist care visits in expansion states compared to non-expansion states, but no significant changes in self-reported physical or mental health. Chima Ndumele reported that plans that stay in the marketplace perform better in terms of quality than those that leave, but that there is no effect of plans leaving on those that stay. A third study from Sara McMenamin analyzed policy options to limit patient cost-sharing for prescription drugs noting that as of the beginning of this year, there were 16 states that have enacted legislation on this topic. In a study looking at high deductible health plan (HDHP) impacts presented by James Wharam, researchers found that women with HDHP experienced delays from diagnoses to treatment. In a similar concerning finding, Jennifer Lewey presented research showing that among commercially insured patients with chronic medical conditions, switching to a HDHP was associated with a significant and immediate decrease in adherence to evidence-based medications.