@article{ref1,
title="Impact of medicaid expansion and firearm legislation on cost of firearm injuries",
journal="American journal of preventive medicine",
year="2023",
author="Brough, Siqi C. and Tennakoon, Lakshika and Spitzer, Sarabeth A. and Thomas, Arielle and Forrester, Joseph D. and Spain, David A. and Weiser, Thomas G.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="INTRODUCTION: Firearm injury-related hospitalizations in the United States cost $900 million annually. Prior to the Affordable Care Act (ACA), government insurance programs covered 41% of costs. This study describes the effect of ACA Medicaid expansion and state level firearm legislation on coverage and costs for firearm injuries. <br><br>METHODS: This cross-sectional study included 35,854,586 hospitalizations from 27 states in 2013 and 2016. Data analyses were performed in 2022. Firearm injuries were classified by mechanism: assault, unintentional, self-harm, or undetermined. Impact of ACA expansion was determined using difference-in-differences analysis. Differences in per capita costs between states with stronger and weak firearm legislation were compared using univariable and multivariable analyses. <br><br>RESULTS: The authors identified 31,451 initial firearm injury-related hospitalizations. In states with weak firearm legislation, hospitalization costs per 100,000 residents were higher from unintentional ($25,834; p=0.04) and self-inflicted injuries ($11,550; p=0.02); there were no state-level differences in assault or total per capita firearm-related hospitalization costs. ACA expansion increased government coverage of costs by 15 percentage points (95% CI 3-29) and decreased costs to uninsured/self-pay by 14 percentage points (95% CI 6-21). In 2016, states with weak firearm legislation and no ACA expansion had the highest proportion of hospitalization costs attributed to uninsured/self-pay patients (24%, 95% CI 15-34). <br><br>CONCLUSIONS: ACA expansion increased government coverage of hospitalizations for firearm injuries. Unintentional and self-harm costs were significantly higher for states with weak firearm legislation. States with weak firearm legislation that did not expand Medicaid had highest proportion of uninsured/self-pay patients. LEVEL OF EVIDENCE: Economic & Value Based Evaluations, Level III.<p /> <p>Language: en</p>",
language="en",
issn="0749-3797",
doi="10.1016/j.amepre.2023.08.011",
url="http://dx.doi.org/10.1016/j.amepre.2023.08.011"
}