Papers by Danny McCormick
Health affairs (Project Hope), Jul 1, 2016
US medical spending growth slowed between 2004 and 2013. At the same time, many Americans faced r... more US medical spending growth slowed between 2004 and 2013. At the same time, many Americans faced rising copayments and deductibles, which may have particularly affected lower-income people. To explore whether the health spending slowdown affected all income groups equally, we divided the population into income quintiles. We then assessed trends in health expenditures by and on behalf of people in each quintile using twenty-two national surveys carried out between 1963 and 2012. Before the 1965 passage of legislation creating Medicare and Medicaid, the lowest income quintile had the lowest expenditures, despite their worse health compared to other income groups. By 1977 the unadjusted expenditures for the lowest quintile exceeded those for all other income groups. This pattern persisted until 2004. Thereafter, expenditures fell for the lowest quintile, while rising more than 10 percent for the middle three quintiles and close to 20 percent for the highest income quintile, which had th...
Annals of Internal Medicine, 2017
Half of Americans have at least 1 chronic disease. Many in this group, particularly racial/ethnic... more Half of Americans have at least 1 chronic disease. Many in this group, particularly racial/ethnic minorities, lacked insurance coverage and access to care before the Patient Protection and Affordable Care Act (ACA) was enacted. To determine whether the ACA has had an effect on insurance coverage, access to care, and racial/ethnic disparities among adults with chronic disease. Quasi-experimental policy intervention. Nationally representative, noninstitutionalized sample in the United States. 606 277 adults aged 18 to 64 years with a chronic disease. Implementation of ACA provisions on 1 January 2014. Self-reported insurance coverage, having a checkup, having a personal physician, and not having to forgo a needed physician visit because of cost. After the ACA was implemented, insurance coverage increased by 4.9 percentage points (95% CI, 4.4 to 5.4), not having to forgo a physician visit increased by 2.4 percentage points (CI, 1.9 to 2.9), and having a checkup increased by 2.7 percentage points (CI, 2.2 to 3.4). Having a personal physician did not change (0.3 percentage points [CI, -0.2 to 0.8]). All outcomes varied considerably by state, and coverage increased more in states that expanded Medicaid. Although racial/ethnic minorities had greater improvements in some outcomes, approximately 1 in 5 black and 1 in 3 Hispanic persons with a chronic disease continued to lack coverage and access to care after ACA implementation. The study examined data from only the first year of the ACA's major coverage expansion provisions. Although the ACA increased coverage and access for persons with chronic disease, substantial gaps remain, particularly for minorities and those in Medicaid nonexpansion states. None.
International journal for equity in health, Jan 18, 2016
The Affordable Care Act was modeled on the Massachusetts Health Reform of 2006, which reduced the... more The Affordable Care Act was modeled on the Massachusetts Health Reform of 2006, which reduced the number of uninsured largely through a Medicaid expansion and the provision of publicly subsidized insurance obtained through a Health Benefits Exchange. We surveyed a convenience sample of 780 patients seeking care in a safety-net system who obtained Medicaid or publicly subsidized insurance after the Massachusetts reform, as well as a group of employed patients with private insurance. We found that although most patients with Medicaid or publicly subsidized exchange-based plans were able to obtain assistance with applying for and choosing an insurance plan, substantial proportions of respondents experienced difficulties with the application process and with understanding coverage and cost features of plans. Under the Affordable Care Act, efforts to simplify the application process and reduce the complexity of plans may be warranted, particularly for vulnerable patient populations cared...
Journal of immigrant and minority health, Jan 26, 2016
Immigrants' perceptions of affordability of insurance and knowledge of insurance after health... more Immigrants' perceptions of affordability of insurance and knowledge of insurance after health reform are unknown. We conducted face-to-face surveys with a convenience sample of 1124 patients in three Massachusetts safety net Emergency Departments after the Massachusetts health reform (August 2013-January 2014), comparing immigrants and non-immigrants. Immigrants, as compared to non-immigrants, reported more concern about paying premiums (30 vs. 11 %, p = 0.0003) and about affording the current ED visit (38 vs. 22 %, p < 0.0001). Immigrants were also less likely to report having unpaid medical bills (24 vs. 32 %, p = 0.0079), however this difference was not present among those with any hospitalization in the past year. Insured immigrants were less likely to know copayment amounts (57 vs. 71 %, p = 0.0018). Immigrants were more likely to report that signing up for insurance would be easier with fewer plans (53 vs. 34 %, p = 0.0443) and to lack information about insurance in the...
Health services research, Oct 8, 2016
Most inpatient care for the uninsured and other vulnerable subpopulations occurs in safety-net ho... more Most inpatient care for the uninsured and other vulnerable subpopulations occurs in safety-net hospitals. As insurance expansion increases the choice of hospitals for the previously uninsured, we examined if Massachusetts health reform was associated with shifts in the volume of inpatient care from safety-net to non-safety-net hospitals overall, or among other vulnerable sociodemographic (racial/ethnic minority, low socioeconomic status, high uninsured rate area) and clinical subpopulations (emergent status, diagnosis). Discharge records for adults discharged from all nonfederal acute care hospitals in Massachusetts, New Jersey, New York, and Pennsylvania 2004-2010. Using a difference-in-differences design, we compared pre-/post-reform changes in safety-net and non-safety-net hospital discharge outcomes in Massachusetts among adults 18-64 with corresponding changes in comparisons states with no reform, overall, and by subpopulations. Reform was not associated with changes in inpatie...
Circulation Cardiovascular Quality and Outcomes, May 1, 2013
Circulation Cardiovascular Quality and Outcomes, Apr 1, 2012
Circulation, Nov 22, 2011
International Journal of Health Services Planning Administration Evaluation, Feb 1, 2002
Older studies have found that minorities in the United States receive fewer mental health service... more Older studies have found that minorities in the United States receive fewer mental health services than whites. This analysis compares rates of outpatient mental health treatment according to race and ethnicity using more recent, population-based data, from the 1997 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. The authors calculated visit rates per 1,000 population to either primary care or psychiatric providers for mental health counseling, psychotherapy, and psychiatric drug therapy. In the primary care setting, Hispanics and blacks had lower visit rates (per 1,000 population) for drug therapy than whites (48.3 and 73.7 vs. 109.0; P <.0001 and P < .01, respectively). Blacks also had a lower visit rate for talk therapy (mental health counseling or psychotherapy) than whites (23.6 vs. 42.5; P < .01). In the psychiatric setting, Hispanics and blacks had lower visit rates than whites for talk therapy (38.4 and 33.6 vs. 85.1; P < .0001 for both comparisons) and drug therapy (38.3 and 29.1 vs. 71.8; P < .0001 for both comparisons). These results indicate that minorities receive about half as much outpatient mental health care as whites.
Circulation Cardiovascular Quality and Outcomes, Apr 1, 2012
Informatics for Health and Social Care, 2016
Text messaging may be an effective method for providing health care reminders to patients. We aim... more Text messaging may be an effective method for providing health care reminders to patients. We aimed to understand patient access to and preferences for receiving health-related reminders via text message among patients receiving care in safety-net hospitals. We conducted face-to-face surveys with 793 patients seeking care in three hospital emergency departments at a large safety-net institution and determined clinical and demographic predictors of preferences for text messaging for health care reminders. 95% of respondents reported having daily access to text messaging. Text messaging was preferred over e-mail, phone, and letters for communication. 78% of respondents wanted to receive appointment reminders, 56% wanted expiring insurance reminders, and 36% wanted reminders to take their medications. We found no clinical predictors but did find some demographic predictors-including age, ethnicity, insurance status, and income-of wanting text message reminders. In our convenience sample of safety-net patients, text messaging is an accessible, acceptable, and patient-preferred modality for receiving health care reminders. Text messaging may be a promising patient-centered approach for providing health care and insurance reminders to patients seeking care at safety-net institutions.
Circulation Cardiovascular Quality and Outcomes, Apr 1, 2012
Circulation Cardiovascular Quality and Outcomes, Nov 1, 2011
Circulation Cardiovascular Quality and Outcomes, Jul 1, 2014
International journal of health services : planning, administration, evaluation, 2015
Twenty-four states have opted out of expanding Medicaid coverage under the Affordable Care Act. W... more Twenty-four states have opted out of expanding Medicaid coverage under the Affordable Care Act. We projected the number of persons who will remain uninsured because of the Medicaid opt-outs and used data from three prior studies to predict the health and financial impacts of the opt-outs. We estimate that as a result of the opt-outs, 7.74 million people who would have gained coverage will remain uninsured. This will result in between 7,076 and 16,945 more deaths than had all states opted-in, as well as 708,195 more persons screening positive for depression, 239,557 more persons suffering catastrophic medical expenditures, 420,273 fewer diabetics receiving medication, 193,735 fewer mammograms, and 441,260 fewer Pap smears. Many low-income adults will suffer health and financial harms because of their state's refusal to expand Medicaid coverage.
International journal of health services : planning, administration, evaluation, Jan 3, 2015
Before the Affordable Care Act (ACA), many surveys showed majority support for national health in... more Before the Affordable Care Act (ACA), many surveys showed majority support for national health insurance (NHI), also known as single payer; however, little is currently known about views of the ACA's targeted population. Massachusetts residents have had seven years of experience with state health care reform that became the model for the ACA. We surveyed 1,151 adults visiting safety-net emergency departments in Massachusetts in late 2013 on their preference for NHI or the Massachusetts reform and on their experiences with insurance. Most of the patients surveyed were low-income and non-white. The majority of patients (72.0%) preferred NHI to the Massachusetts reform. Support for NHI among those with public insurance, commercial insurance, and no insurance was 68.9%, 70.3%, and 86.3%, respectively (p < .001). Support for NHI was higher among patients dissatisfied with their insurance plan (83.3% vs. 68.9%, p = .014), who delayed medical care (81.2% vs. 69.6%, p < .001) or a...
American journal of public health, Jan 12, 2015
We sought to determine the association between Medicaid coverage and the receipt of appropriate c... more We sought to determine the association between Medicaid coverage and the receipt of appropriate clinical care. Using the 1999 to 2012 National Health and Nutritional Examination Surveys, we identified adults aged 18 to 64 years with incomes below the federal poverty level, and compared outpatient visit frequency, awareness, and control of chronic diseases between the uninsured (n = 2975) and those who had Medicaid (n = 1485). Respondents with Medicaid were more likely than the uninsured to have at least 1 outpatient physician visit annually, after we controlled for patient characteristics (odds ratio [OR] = 5.0; 95% confidence interval [CI] = 3.8, 6.6). Among poor persons with evidence of hypertension, Medicaid coverage was associated with greater awareness (OR = 1.83; 95% CI = 1.26, 2.66) and control (OR = 1.69; 95% CI = 1.32, 2.27) of their condition. Medicaid coverage was also associated with awareness of being overweight (OR = 1.30; 95% CI = 1.02, 1.67), but not with awareness o...
International journal for equity in health, Jan 29, 2015
Under the Massachusetts health reform, low income residents (those with incomes below 150 % of th... more Under the Massachusetts health reform, low income residents (those with incomes below 150 % of the Federal Poverty Level [FPL]) were eligible for Medicaid and health insurance exchange-based plans with minimal cost-sharing and no premiums. Those with slightly higher incomes (150 %-300 % FPL) were eligible for exchange-based plans that required cost-sharing and premium payments. We conducted face to face surveys in four languages with a convenience sample of 976 patients seeking care at three hospital emergency departments five years after Massachusetts reform. We compared perceived affordability of insurance, financial burden, and satisfaction among low cost sharing plan recipients (recipients of Medicaid and insurance exchange-based plans with minimal cost-sharing and no premiums), high cost sharing plan recipients (recipients of exchange-based plans that required cost-sharing and premium payments) and the commercially insured. We found that despite having higher incomes, higher co...
International journal for equity in health, Jan 29, 2015
The Affordable Care Act (ACA) and the 2006 Massachusetts (MA) health reform law, on which the ACA... more The Affordable Care Act (ACA) and the 2006 Massachusetts (MA) health reform law, on which the ACA was based, aimed to improve the affordability of care largely by expanding publicly sponsored insurances. Both laws also aimed to promote consumer understanding of how to acquire, maintain and use these public plans. A prior study found an association between the level of cost-sharing required in these plans and the affordability of care. Preparatory to a quantitative study we conducted this qualitative study that aimed to examine (1) whether cost sharing levels built into the public insurance types that formed the backbone of the MA health reform led to unaffordability of care and if so, (2) how insurances with higher cost sharing levels led to unaffordability of care in this context. We interviewed 12 consumers obtaining the most commonly obtained insurances under MA health reform (Medicaid and Commonwealth Care) at a safety net hospital emergency department. We purposefully interview...
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Papers by Danny McCormick