TY  - JOUR
PY  - 2023//
TI  - Impact of medicaid expansion and firearm legislation on cost of firearm injuries
JO  - American journal of preventive medicine
A1  - Brough, Siqi C.
A1  - Tennakoon, Lakshika
A1  - Spitzer, Sarabeth A.
A1  - Thomas, Arielle
A1  - Forrester, Joseph D.
A1  - Spain, David A.
A1  - Weiser, Thomas G.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - 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>
LA  - en
SN  - 0749-3797
UR  - http://dx.doi.org/10.1016/j.amepre.2023.08.011
ID  - ref1
ER  -