# Effects of Affordable Care Act Medicaid Expansion on Disparities in Trauma Care and Outcomes in Young Adults

> **NIH NIH R01** · RESEARCH INST NATIONWIDE CHILDREN'S HOSP · 2021 · $241,602

## Abstract

Project Summary/Abstract
 Trauma is the leading cause of death and disability among young adults in the United States. Trauma
affects all segments of the US population, but large disparities exist in access to high quality trauma care and
outcomes after injury. Among young adults, uninsured patients, patients who reside in low income
communities, and black patients have higher risk-adjusted rates of in-hospital mortality. Low income and black
and Hispanic patients are also less likely to receive rehabilitative care after injury. These socioeconomic and
racial/ethnic disparities are reduced among insured patients. Prior to the implementation of the Affordable Care
Act (ACA), more than 20% of hospitalized trauma patients were uninsured, with this proportion being much
higher among low income and racial/ethnic minority patients. Medicaid expansion through the ACA was
implemented to increase health insurance coverage among low income adults. It has reduced the percentage
of trauma patients who are uninsured. However, its effects nationally on the known socioeconomic and
racial/ethnic disparities that exist in trauma care and outcomes remain unclear. Lack of insurance is not the
only mechanism underlying these disparities as being uninsured is correlated with numerous factors that may
independently affect trauma outcomes, such as poorer pre-injury health status, greater treatment delay,
provider bias, and treatment at lower resourced hospitals. However, evidence for the direct impact of insurance
coverage on disparities in trauma outcomes comes from populations with universal insurance coverage such
as the elderly and military personnel, in whom these disparities are not seen. Further research is needed to
understand the effect of ACA Medicaid expansion on racial/ethnic and socioeconomic disparities in trauma
care and outcomes and elucidate the mechanisms by which this policy may have reduced these disparities.
This project will utilize 2010-2017 State Inpatient and State Emergency Department Databases from 18 US
states as well as data on hospital structural and financial characteristics to evaluate the effect of ACA Medicaid
expansion on socioeconomic and racial/ethnic disparities in trauma care and outcomes among young adults
hospitalized for injury. We aim to evaluate whether ACA Medicaid expansion has mitigated disparities in in-
hospital mortality, transfer patterns, unplanned readmissions, and access to rehabilitative care after serious
injury for Non-Hispanic black patients, Hispanic patients, and patients from low income communities. We also
aim to determine what types of hospitals have experienced the largest improvements in outcomes among their
minority and low socioeconomic status young adult trauma patients. This project will provide policy makers and
healthcare providers with a clear picture of the impact of health insurance expansion to low income adults on
racial/ethnic and socioeconomic disparities in trauma outcomes. With the federal ...

## Key facts

- **NIH application ID:** 10069232
- **Project number:** 5R01MD013881-03
- **Recipient organization:** RESEARCH INST NATIONWIDE CHILDREN'S HOSP
- **Principal Investigator:** Jennifer N. Cooper
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $241,602
- **Award type:** 5
- **Project period:** 2019-04-26 → 2022-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10069232

## Citation

> US National Institutes of Health, RePORTER application 10069232, Effects of Affordable Care Act Medicaid Expansion on Disparities in Trauma Care and Outcomes in Young Adults (5R01MD013881-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10069232. Licensed CC0.

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