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Importance Several recent policy proposals have sought to expand the role of Medicaid in providing health insurance for low-income Americans, but there is little recent information on how physician participation in Medicaid compares with alternative forms of coverage for low-income Americans. Objective To compare the number of office-based physicians included in Medicaid managed care and health insurance exchange plans that operate in the same geographic markets. Design, Setting, and Participants This cross-sectional study used administrative data from physician network directories and survey data from office-based physicians for Kansas, Nebraska, New York, Tennessee, and Washington. The number of participants totaled 67 057 office-based physicians in the 5 sample states. Data were collected and analyzed from May 2018 to June 2019. Exposures Physician participation in a Medicaid managed care or health insurance exchange plan network. Main Outcomes and Measures The percentage of office-based physicians in a county who indicated during a phone survey that they participated in Medicaid; the percentage of office-based physicians in a county who participated in each Medicaid managed care and health insurance exchange plan network; and the percentage of office-based physicians in a county who participated in at least one Medicaid managed care plan or, separately, at least one health insurance exchange plan. Results Of the 67 057 office-based physicians in our sample, 49 983 reported in a telephone survey that they accepted Medicaid. This survey-based measure undercounted the percentage of physicians participating in Medicaid by 5.2% (95% CI, 2.3%-8.1%; P < .001) relative to a measure based on physician network directories. Medicaid managed care physician networks covered a mean (SD) of 63.4% (20.5%) of office-based physicians compared with health insurance exchange physician networks, which covered 51.0% (25.2%). In adjusted analyses, Medicaid managed care plans covered 6.2% (95% CI, 3.2%-9.3%, P < .001) more office-based physicians than health insurance exchange plans operating in the same counties. In the states where the same insurers participated in both markets (New York, Tennessee, Washington), the Medicaid managed care physician networks were 6.5% (95% CI, 3.2%-9.8%, P < .001) larger than the health insurance exchange networks offered by the same insurer. Conclusions and Relevance In this cross-sectional study of physician network data, Medicaid managed care physician networks included more office-based physicians than the physician networks of health insurance exchange plans operating in the same geographic markets. This suggests that Medicaid remains a viable option for expanding coverage in the United States. [ABSTRACT FROM AUTHOR]

Competing Interests: Disclosures Drs Lu and Krumholz had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr Jastreboff conducts multicenter trials with Eli Lilly, Novo Nordisk, and Rhythm Pharmaceuticals; serves on scientific advisory boards for Amgen, AstraZeneca, Boehringer Ingelheim, Biohaven, Eli Lilly, Intellihealth, Novo Nordisk, Pfizer, Rhythm Pharmaceuticals, Scholar Rock, Structure Therapeutics, Terms Pharmaceutical, WeightWatchers, and Zealand Pharmaceuticals; was the site principal investigator for the SELECT (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity) trial at Yale University; and receives institutional grant funding from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. Dr Rodriguez reports consulting relationships with Healthpals, Novartis, Esperion, NovoNordisk (Clinical Events Committee), Movano Health, and Kento Health. In the past three years, Harlan Krumholz received expenses or personal fees from Element Science, Eyedentify, and F-Prime. He is a co-founder of Hugo Health, Refactor Health, and Ensight-AI. He is the co-editor of Journal Watch: Cardiology of the Massachusetts Medical Society and is a section editor of UpToDate. He is associated with contracts, through Yale New Haven Hospital, from the Centers for Medicare & Medicaid Services and through Yale University from Janssen, Johnson & Johnson Consumer, and Pfizer. Dr. Lu received support from the Sentara Research Foundation, the National Heart, Lung, and Blood Institute of the National Institutes of Health (under awards R01HL69954 and R01HL169171), and the Patient-Centered Outcomes Research Institute (under award HM-2022C2-28354). Dr. Khera is an Associate Editor of JAMA. He receives support from the National Heart, Lung, and Blood Institute of the National Institutes of Health (under award K23HL153775) and the Doris Duke Charitable Foundation (under award 2022060). He also receives research support, through Yale, from Bristol-Myers Squibb and Novo Nordisk. He is a coinventor of U.S. Provisional Patent Applications 63/177,117, 63/428,569, 63/346,610, 63/484,426, and 63/508,315. He is a co-founder of Ensight-AI and Evidence2Health, health platforms to improve cardiovascular diagnosis and evidence-based cardiovascular care. All data used in this study are publicly available at https://www.cdc.gov/nchs/nhanes/index.htm. The other authors report no conflicts.

Objective: To determine whether health systems in the United States modify treatment or discharge decisions for otherwise similar patients based on health insurance coverage., Design: Regression discontinuity approach., Setting: American College of Surgeons' National Trauma Data Bank, 2007-17., Participants: Adults aged between 50 and 79 years with a total of 1 586 577 trauma encounters at level I and level II trauma centers in the US., Interventions: Eligibility for Medicare at age 65 years., Main Outcome Measures: The main outcome measure was change in health insurance coverage, complications, in-hospital mortality, processes of care in the trauma bay, treatment patterns during hospital admission, and discharge locations at age 65 years., Results: 1 586 577 trauma encounters were included. At age 65, a discontinuous increase of 9.6 percentage points (95% confidence interval 9.1 to 10.1) was observed in the share of patients with health insurance coverage through Medicare at age 65 years. Entry to Medicare at age 65 was also associated with a decrease in length of hospital stay for each encounter, of 0.33 days (95% confidence interval -0.42 to -0.24 days), or nearly 5%), which coincided with an increase in discharges to nursing homes (1.56 percentage points, 95% confidence interval 0.94 to 2.16 percentage points) and transfers to other inpatient facilities (0.57 percentage points, 0.33 to 0.80 percentage points), and a large decrease in discharges to home (1.99 percentage points, -2.73 to -1.27 percentage points). Relatively small (or no) changes were observed in treatment patterns during the patients' hospital admission, including no changes in potentially life saving treatments (eg, blood transfusions) or mortality., Conclusions: The findings suggest that differences in treatment for otherwise similar patients with trauma with different forms of insurance coverage arose during the discharge planning process, with little evidence that health systems modified treatment decisions based on patients' coverage., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at https://icmje.org/disclosure-of-interest/ and declare: no support from any organization for the submitted work; support from the Agency for Healthcare Research and Quality for JWS as principal investigator (grant K08-HS028672) and as a co-investigator (grant R01-HS027788). JWS also receives salary support from Blue Cross Blue Shield of Michigan through the collaborative quality initiative known as Michigan Social Health Interventions to Eliminate Disparities (MSHIELD), outside the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)