Impact of the Affordable Care Act on Glaucoma Severity at First Presentation

Abstract

Purpose: To test whether the increase in insurance coverage in Massachusetts due to the Affordable Care Act (ACA) is associated with a decrease in glaucoma severity in patients presenting for the first time at a tertiary health system.

Methods: Clinical and billing data of first-time glaucoma patients from a tertiary health system in Massachusetts from 2006 to 2021 was used. Pre-ACA is defined as before 2014 and post-ACA is defined as after 2014. Visual field mean deviation was used to define glaucoma severity: greater than -6 dB, less than -6 dB and greater than -12 dB, and less than -12 dB was classified as “mild,” “moderate,” and “severe” respectively. Ordinal logistic regression models adjusted for age, race, gender, and insurance type were used to determine the odds of presenting with more severe glaucoma.

Results: 2,394 pre-ACA and 3,651 post-ACA first-time glaucoma patients were identified. There was no significant difference in the likelihood of more severe glaucoma at first presentation post-ACA compared to pre-ACA (OR=0.96; 95% CI 0.86-1.08; p=0.49) among the entire population. In stratified analyses, patients who utilized Medicaid for insurance had 52% decreased odds for presenting with more severe glaucoma at first presentation post-ACA compared to pre-ACA (OR=0.48; 95% CI 0.33-0.69; p<0.001). This remained significant after adjustment for age, race, and gender (adjusted OR=0.44; 95% CI 0.29-0.65; p<0.001).

Conclusion: At a Massachusetts-based tertiary healthcare center, individuals on Medicaid were more likely to have more severe glaucoma at first presentation before the implementation of the ACA, compared to after.

KEYWORDS:

• Glaucoma
• affordable care act
• health insurance
• policy

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported in part by the NIH K23 Career Development Award (K23EY032634) (NZ), NIH R21 Exploratory/Developmental Research Grant Award (1R21EY032953), Research to Prevent Blindness Career Development Award (NZ), NIH R01 Research Project Grant (EY030575) (TE), and NIH P30 Core Grant for Vision Research (EY003790) (TE; Harper-Inglis Memorial for Eye Research, The Peierls Foundation, That Man May See, and Research to Prevent Blindness; National Institutes of Health [EY030575, EY003790,K23EY032634, 1R21EY032953]