Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Ninani Kombo

Abstract

Introduction: Access to quality eyecare is important for early diagnosis and prevention of vision loss. Understanding the role of Medicaid expansion (as a result of the Affordable Care Act) in improving eye health outcomes has the potential to guide health policy and address disparities in vision care in the United States. Here, we investigate the impact of Medicaid expansion on access to eyecare among low-income adults across the United States.

Methods: Survey data was extracted from the National Health Interview Survey (NHIS) for the years 2010 through 2018 for adults aged 18-64 years with a family income less than 125% of the federal poverty level (FPL). Pre-expansion (2010-2013) and post-expansion (2015-2018) cohorts were compared using Chi-squared (χ²) tests, logistic regression, and difference-in-differences analysis to assess changes in insurance status, access to eye care services, affordability of eyeglasses, and self-reported blindness. Subgroup analyses were conducted to examine differences by age group, sex, race/ethnicity, and education level. Statistical analyses were conducted using Python 3.9.13 with a statistical significance of p < 0.05.

Results: A total of 90,521 adults were included in our analysis. Post-expansion, uninsured rates decreased by 17.2% (p < 0.001), with Medicaid coverage rising by 11.8% (p < 0.001). Annual eyecare visit rate increased from 23.9% to 28.7% (p < 0.001), while annual rate of individuals’ inability to afford eyeglasses decreased from 17.9% to 14.1% (p < 0.001). Multiple regression analysis confirmed Medicaid expansion’s association with increased odds of individuals being insured (OR = 1.964) and having a recent eyecare visit (OR = 1.209), with lower odds of being unable to afford eyeglasses (OR = 0.739). Difference-in-differences analysis comparing a Medicaid-eligible population to higher-income individuals showed significant increases in Medicaid coverage (OR = 1.139), private insurance coverage (OR = 1.202), and odds of annual eyecare usage (OR = 1.051), providing evidence of Medicaid expansion’s causal effect.

Conclusion: Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) has significantly improved insurance coverage and eyecare access for low-income adults. However, gaps remain in eyecare access, highlighting the need for additional targeted policies and strategies to mitigate these disparities and create equitable access to vision care.

Comments

This is an Open Access Thesis.

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