The Affordable Care Act and Stroke
The Patient Protection and Affordable Care Act (ACA) was enacted on March 23, 2010, and has important implications for stroke care. The ACA is a comprehensive reform, although the signature component is the expansion of health insurance primarily by expanding Medicaid eligibility and by providing subsidies for consumers to purchase private insurance in online marketplaces called exchanges. Although many ACA provisions went into effect with its passage or have been phased in during the past several years, the Medicaid expansion and insurance exchanges went into effect more recently in January 2014. In this article, we begin by describing the working-age stroke population. We then discuss the health insurance provisions of the ACA, which largely target the working-age stroke population, and implications for racial/ethnic and geographic disparities. We then focus on how the ACA may affect stroke prevention, treatment, and postacute care (PAC). We conclude by discussing how health system reform under the ACA could affect patients with stroke.
Stroke Among Working-Age Americans
Working-age Americans, those aged 19 to 64 years, are experiencing stable or increasing stroke incidence even as overall stroke incidence is decreasing over time.1,2 Although racial and ethnic stroke disparities are present overall, the largest disparities are found among working-age Americans.1,2 To provide national estimates of stroke hospitalizations and insurance status among the working-age population, we used data from the Nationwide Inpatient Sample, a nationally representative sample of hospitalizations (for detailed methods, see online-only Data Supplement).
In 2010, ≈230 000 or 37% of all stroke hospitalizations were among patients aged <65 years. Of the working-age stroke hospitalizations, 20% were among patients who had Medicaid and 14% were among uninsured. Disparities in stroke hospitalizations and insurance status, particularly among blacks, are striking. First, hospitalizations among the working age are more frequent in blacks (26.5%) than would be …