Research Roundup: A Primer On Medicaid Expansion; Health Costs Of Smokers, Churn In The Individual Insurance Market

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Annals Of Internal Medicine: Health Policy Basics: Medicaid Expansion
Medicaid is the largest single source of health insurance coverage in the United States, providing insurance for more than 62 million persons and families in 2013. The Patient Protection and Affordable Care Act sought to expand Medicaid eligibility to nearly all low-income persons with incomes up to 138% of the federal poverty level. However, the U.S. Supreme Court ruled that states' expansion would be optional. Although more than half of the states and the District of Columbia have opted to expand Medicaid starting in 2014, many states continue to oppose increasing access to the program. This article will discuss the basic provisions of the expansion and the benefits and challenges patients and physicians may face as Medicaid grows (Crowley and Golden, 12/24).

JAMA Internal Medicine: Preoperative Consultations For Medicare Patients Undergoing Cataract Surgery
Low-risk elective surgical procedures are common, but there are no clear guidelines for when preoperative consultations are required. Such consultations may therefore represent a substantial discretionary service. ... Cohort study using a 5% national random sample of Medicare part B claims data including a cohort of 556,637 patients 66 years or older who underwent cataract surgery from 1995 to 2006. ... The frequency of preoperative consultations increased from 11.3% in 1998 to 18.4% in 2006..... Variation in frequency of consultation across hospital referral regions was substantial, even after accounting for differences in patient-level, anesthesia provider–level, and facility-level characteristics. ... Referrals for consultation seem to be primarily driven by nonmedical factors (Thilen et al., 12/23).

JAMA Surgery: Smoking Status And Health Care Costs In The Perioperative Period
Cigarette smoking increases complication risk in surgical patients, but the potential effects of smoking status on perioperative health care costs are unclear. ... This population-based, propensity-matched cohort study, with cohort membership based on smoking status (current smokers, former smokers, and never smokers) was performed at Mayo Clinic in Rochester ... Compared with never smokers, health care costs during the first year after hospital discharge for an inpatient surgical procedure are higher in both former and current smokers, although the cost of the index hospitalization is not affected by smoking status (Warner et al., 1/1).

JAMA Psychiatry: Race/Ethnicity And Geographic Access To Medicaid Substance Use Disorder Treatment Facilities In The United States
Although substance use disorders (SUDs) are prevalent and associated with adverse consequences, treatment rates remain low. ... We used data from the 2009 National Survey of Substance Abuse Treatment Services public use file and the 2011-2012 Area Resource file to examine sociodemographic factors associated with county-level access to SUD treatment facilities that serve Medicaid enrollees. ...  Approximately 60% of US counties have at least 1 outpatient SUD facility that accepts Medicaid, although this rate is lower in many Southern and Midwestern states. ... The potential for increasing access to SUD treatment via Medicaid expansion may be tempered by the local availability of facilities to provide care, particularly for counties with a high percentage of black and/or uninsured residents and for rural counties (Cummings, Wen, Ko and Druss, 12/25).

JAMA Psychiatry: Comorbidity Of Severe Psychotic Disorders With Measures Of Substance Use
Although early mortality in severe psychiatric illness is linked to smoking and alcohol, to our knowledge, no studies have comprehensively characterized substance use behavior in severe psychotic illness. In particular, recent assessments of substance use in individuals with mental illness are based on population surveys that do not include individuals with severe psychotic illness. ... We assessed comorbidity between substance use and severe psychotic disorders in the Genomic Psychiatry Cohort. ... Relative to the general population, individuals with severe psychotic disorders have increased risks for smoking, heavy alcohol use, heavy marijuana use and recreational drug use.... Of specific concern, recent public health efforts that have successfully decreased smoking among individuals younger than age 30 years appear to have been ineffective among individuals with severe psychotic illness (Hartz et al., 1/1).

The Kaiser Family Foundation: Data Note: How Many People Have Nongroup Health Insurance?
The implementation of the Affordable Care Act (ACA) has focused attention on the composition of the nongroup market: how it looked before the new regulatory provisions take effect and how it will change afterwards. ... The pre-reform nongroup market is complicated. It was fairly small, serving less than 5 percent of the nonelderly population, with a much smaller population relying on the nongroup market as their only source of coverage. In addition, the nongroup market experiences substantial turnover. ... The turnover in, and varied populations served by, the pre-reform nongroup market have posed challenges for analysts and others trying to understand the changes occurring under the ACA. The number of people who have and keep nongroup coverage as their primary source of protection is considerably smaller than the number of people in the market at any given point in time. A considerably larger number of people have nongroup coverage sometime during a year, but many have short tenures and may or may not experience any of the changes underway. Looking forward, the size of the market is predicted to grow dramatically as millions of uninsured people, many assisted by new premium tax credits, obtain and retain nongroup coverage (Claxton, Levitt, Damico and Rae, 1/3).

American Journal of Critical Care: Association Of Sleep And Fatigue With Decision Regret Among Critical Care Nurses 
Fatigued nurses are more likely than well-rested nurses to make faulty decisions that lead to decision regret, a negative cognitive emotion that occurs when the actual outcome differs from the desired or expected outcome. ... Nurses with decision regret reported more fatigue, more daytime sleepiness, less intershift recovery, and worse sleep quality than did nurses without decision regret. Being male, working a 12-hour shift, and clinical-decision satisfaction were significantly associated with decision regret (Scott, Arslanian-Engoren, Engoren, Jan. 2014).

Journal of General Internal Medicine: National Study Of Health Insurance Type And Reasons For Emergency Department Use
This was a cross-sectional analysis of the 2011 National Health Interview Survey. Adults whose last ED visit did not result in hospitalization (n = 4,606) were asked structured questions about reasons for seeking ED care. We classified responses as 1) perceived need for immediate evaluation (acuity issues), or 2) barriers to accessing outpatient services (access issues). ... Relative to those with private insurance, adults with Medicaid and those with Medicare were similarly likely to seek ED care due to an acuity issue. Adults with Medicaid and Medicaid + Medicare (dual eligible) were more likely than those with private insurance to seek ED care for access issues. ... Policymakers should focus on increasing access to alternate sites of care, particularly for Medicaid beneficiaries, as well as strategies to increase care coordination that involve ED patients and providers (Capp et al., 12/2013).

Here is a selection of news coverage of other recent research:

The New York Times: Common Knee Surgery Does Very Little For Some, Study Suggests
A popular surgical procedure worked no better than fake operations in helping people with one type of common knee problem, suggesting that thousands of people may be undergoing unnecessary surgery, a new study in The New England Journal of Medicine reports. The unusual study involved people with a torn meniscus, crescent-shaped cartilage that helps cushion and stabilize knees. Arthroscopic surgery on the meniscus is the most common orthopedic procedure in the United States, performed, the study said, about 700,000 times a year at an estimated cost of $4 billion (Belluck, 12/25).

MedPage Today: USPSTF Finalizes Lung Screening Recs
Annual low-dose CT screening for lung cancer is recommended for high-risk individuals, the U.S. Preventive Services Task Force (USPSTF) announced. The final grade B recommendation [is] for adults ages 55 through 79 with a 30 pack-year history of smoking or who have quit in the past 15 years ... The draft had included in the clinical considerations section a recommendation against screening individuals with significant comorbidity, especially those nearing the age cutoff of 80. The final recommendation, published online Monday in Annals of Internal Medicine, ... repeated it again in the main body of the document (Phend, 12/30/13).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.