The Affordable Care Act Medicaid Expansion and Smoking Cessation Among Low-Income Smokers.

Autor: Donahoe JT; Graduate School of Arts and Sciences, Harvard University, Cambridge, Massachusetts. Electronic address: jtdonahoe@g.harvard.edu., Norton EC; Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan; Department of Economics, University of Michigan, Ann Arbor, Michigan; National Bureau of Economic Research, Cambridge, Massachusetts., Elliott MR; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan., Titus AR; Center for Social Epidemiology & Population Health, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan., Kalousová L; Department of Sociology, University of California‒Riverside, Riverside, California., Fleischer NL; Center for Social Epidemiology & Population Health, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
Jazyk: angličtina
Zdroj: American journal of preventive medicine [Am J Prev Med] 2019 Dec; Vol. 57 (6), pp. e203-e210.
DOI: 10.1016/j.amepre.2019.07.004
Abstrakt: Introduction: This study sought to empirically evaluate whether the Medicaid expansion under the Affordable Care Act increased smoking cessation among low-income childless adult smokers.
Methods: The effects of the Medicaid expansion on smoking quit attempts and the probability of 30- and 90-day smoking cessation were evaluated using logistic regression and data from the 2010-2011 and 2014-2015 waves of the Tobacco Use Supplement to the Current Population Survey. Using boosted logistic regression, the Tobacco Use Supplement was restricted to an analytic sample composed of childless adults with high probability of being <138% of the federal poverty level. Propensity score weighting was used to compare changes in smoking cessation among a sample of current and past smokers in states that expanded Medicaid with a control sample of current and past smokers in states that did not expand Medicaid with similar sociodemographic characteristics and smoking histories. This study additionally controlled for state socioeconomic trends, welfare policies, and tobacco control policies. Analysis was conducted between January 2018 and June 2019.
Results: After weighting by propensity score and adjusting for state socioeconomic trends, welfare policies, and tobacco control policies, the Medicaid expansion was not associated with increases in smoking quit attempts or smoking cessation.
Conclusions: The Medicaid expansion did not appear to improve smoking cessation, despite extending health insurance eligibility to 2.3 million low-income smokers. Greater commitments to reducing barriers to cessation benefits and increasing smoking cessation in state Medicaid programs are needed to reduce smoking in low-income populations.
(Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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