Changes in dental visits and expenditures in veterans, older adults, and foreign-born after affordable care act repeal efforts: A quasi-experimental difference-in-differences study

INTRODUCTIONThe Patient Protection and Affordable Care Act (ACA) faced political and legal challenges before and after enactment, and through implementation, including serious attempts at repealing and dismantling its main provisions in 2017.We assessed the relationship between ACA implementation (indicated as a state expanding Medicaid), dental visits, and costs among US military veterans, older adults aged 65 years, and foreign-born individuals following ACA repeal efforts.METHODS Using data from the 2016-2018 Medical Expenditure Panel Surveys, logistic and two-part regressions were used to model dental visits and costs as a function of key explanatory variables.Differences-in-differences estimates compared changes in dental visits and costs in Medicaid expansion to non-expansion states in pre-repeal (2016) versus repeal (2017-2018) time periods.RESULTS Post-ACA repeal efforts, multivariable analysis conducted among all US adults showed that individuals in Medicaid expansion states had higher odds of reporting a dental visit compared to those in a non-Medicaid expansion state (AOR=1.09;95% CI: 1.02-1.16;p=0.009).In subgroup analysis, veterans in Medicaid expansion states had significantly higher odds of a past-year dental visit compared to those in non-Medicaid expansion states (AOR=1.28;95% CI: 1.07-1.52;p=0.006).No significant changes in past-year dental visits were noted for older adults and the foreign-born in Medicaid expansion states.Regarding health expenditures, veterans, older adults, and foreign-born individuals in Medicaid expansion states all spent significantly more than the predicted average expenditure on dental visits following ACA repeal efforts, compared to those in non-Medicaid expansion states.CONCLUSIONS The findings of this study suggest that the ACA, through expansion of Medicaid programs, improved access for veterans' post-ACA repeal efforts but without the cost savings typical to ACA implementation.Efforts to completely repeal or modify important ACA components result in higher expenditures whether health service utilization increases or not.