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Access to Elective Orthopaedic Surgery After the Affordable Care Act Medicaid Expansion

The New York State Experience

Williamson, Tyler R. MD; Paoli, Albit R. BS; Hutzler, Lorraine MPA; Zuckerman, Joseph MD; Bosco, Joseph III MD

Journal of the American Academy of Orthopaedic Surgeons: July 30, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.5435/JAAOS-D-18-00062
Research Article: PDF Only

Background: As part of the Patient Protection and Affordable Care Act, states were given the option of expanding Medicaid coverage to include adults younger than age 65 years with income at or below 138% of the federal poverty level. Although this expansion was intended to provide health care coverage to an estimated 20 million Americans, several studies have shown increased coverage does not equate to increased access to care by specialty providers.

Methods: We queried the New York Statewide Planning and Research Cooperative System database and identified all patients who underwent the 10 most common elective orthopaedic surgeries from January 1, 2012, through March 31, 2016. Medicaid monthly enrollment for the 4-year study period was obtained from NY Department of Health Medicaid Managed Care Enrollment Reports.

Results: Our query identified 700,159 patients who underwent the investigated orthopaedic surgeries. Of these, 60,786 were Medicaid recipients. During the 4-year study period, Medicaid enrollment and the number of procedures reimbursed by Medicaid increased significantly (P < 0.001 for both).

Conclusions: Affordable Care Act–supported Medicaid expansion was associated with an increase in Medicaid enrollment and a concomitant increase in the utilization of orthopaedic surgery by Medicaid beneficiaries in New York State.

From the Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY.

Correspondence to Ms. Hutzler:

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Williamson, Mr. Paoli, Ms. Hutzler, Dr. Zuckerman, and Dr. Bosco.

© 2019 by American Academy of Orthopaedic Surgeons
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