Medicaid Expansion Under the Affordable Care Act and Pediatric Trauma Patient Insurance Coverage

Area of Science:

• Pediatric Trauma Care
• Health Policy and Insurance
• Public Health Outcomes

Background:

• Uninsured pediatric trauma patients face higher risks of adverse outcomes.
• The impact of the Patient Protection and Affordable Care Act (ACA) on this population remains understudied.
• The ACA aimed to expand insurance coverage, potentially affecting vulnerable groups like pediatric trauma patients.

Purpose of the Study:

• To investigate the association between Medicaid expansion under the ACA and insurance coverage rates in pediatric trauma patients.
• To evaluate the impact of ACA-driven Medicaid expansion on key outcomes for pediatric trauma patients.
• To determine if increased insurance coverage translates to improved patient outcomes.

Main Methods:

• Retrospective review of 5645 pediatric trauma patients (<18 years) treated at a Level 1 trauma center from 2009-2019.
• Interrupted time series analysis to assess the effects of Medicaid expansion implemented in January 2014.
• Primary outcome: insurance coverage rate. Secondary outcomes: in-hospital mortality, disposition, 30-day readmission, length of stay (LOS), and intensive care unit (ICU) LOS.

Main Results:

• Medicaid expansion was linked to minimal changes in insurance coverage among pediatric trauma patients.
• A slight decrease in in-hospital mortality (RR=0.96, P=0.0355) and ICU LOS (P<0.0001) was observed.
• No significant associations were found with 30-day readmission or overall length of stay.

Conclusions:

• Medicaid expansion under the ACA demonstrated marginal effects on insurance coverage for pediatric trauma patients.
• Significant improvements in overall patient outcomes were not identified following Medicaid expansion.
• While mortality and ICU LOS saw slight reductions, the broader impact on pediatric trauma care outcomes remains limited.