Health Policy Research

Public agencies and private organizations implement various practices, programs, and requirements to improve healthcare and address challenges health systems, providers, and patients may face. Health policy research aims to understand the impact of health policies on healthcare and health and how different factors influence health-related policies and their implementation.

One of the recent most comprehensive US healthcare reforms was the Patient Protection and Affordable Care Act (ACA). The ACA aimed to provide health insurance coverage to all US citizens and legal residents by expanding the Medicaid program to cover all adults with incomes below 138% of the federal poverty level and offering the ability to purchase individual health insurance though federal or state marketplaces. Some states implemented ACA Medicaid expansion while other states did not implement it, thus creating a natural experiment to study the impact of this policy on multiple aspects of healthcare.

Our Research

Our research is important for future health policy and healthcare practice and provides evidence to improve the US healthcare system and mitigate disparities in prevention and treatment of prevalent health conditions among underserved populations.

Specifically, we evaluate the impact of the ACA Medicaid expansion on care provided by community health centers (CHCs), which serve patients regardless of their ability to pay for services. Our studies assess the short- and long-term effects of the ACA on healthcare services provided by CHCs for several prevalent health conditions such as diabetes, cancer, and hypertension. We compare health outcomes in expansion and non-expansion states before and after the ACA Medicaid expansion began in 2014.

Our Projects


Access publications associated with these projects here

Studies in Progress

Evaluate Health Insurance Expansion on Cancer Preventive Care Among Latino Populations (ALL-IN)

PI: Nathalie Huguet, PhD

Funding: American Cancer Society

The study aims to understand the impact of California and Oregon Medicaid eligibility expansion to adults regardless of immigration status on access to care and receipt of cancer preventive care. I will focus on the Latino population receiving care in community-based clinics.  This study will inform future state decisions to expand Medicaid eligibility and further improvements in the US healthcare system to mitigate disparities in cancer preventive care.

Assessment of Medicaid Policy on Smoking Cessation Assistance and Surgical Outcomes (ASSIST)

PIs: Steffani Bailey, PhD; Nathalie Huguet, PhD

Funding: National Institute on Minority Health and Health Disparities 

This study aims to evaluate the reach, effectiveness, implementation, and potential unintended consequences of an Oregon Medicaid guideline requiring smoking cessation prior to elective surgery. It will assess outcomes such as smoking cessation, receipt of smoking cessation assistance, surgery rates, surgery complication rates, and experiences and perception with this guideline from clinicians, patients, and medical directors. This study can inform decisions of policy makers, health care providers, and health systems related to adopting and implementing similar policies which could disproportionately impact those of lower socioeconomic status

Assess insurance Coverage Expansion on Diabetes complications (ACE-D)

PI: Nathalie Huguet, PhD

Funding: Centers for Disease Control and Prevention/ National Institute of Diabetes and Digestive and Kidney Diseases

Built on the findings from PREVENT-D, this study aims to understand the long-term impact of the ACA Medicaid expansions on acute and chronic diabetes-related complications and mortality. It will also examine the interplay between social determinants of health (SDH) and health insurance coverage. The study is part of Natural EXperiments for Translation in Diabetes (NEXT-D3) network, a collaboration of eight research team from major US institutions for evaluating the impact of health policies on diabetes care and prevention.

Completed Studies

Evaluating Control of Hypertension - Effect of Social Determinants (ECHOES)

PI: Jennifer E DeVoe, MD, DPhil

Funding: National Heart Lung-Blood Institute

This study evaluates the impact of increased access to health insurance following ACA Medicaid expansion on hypertension incidence, screening, treatment, and management.

Post Affordable Care Act: Evaluation of Community Health Centers (PACE)

PI: Jennifer E DeVoe, MD, DPhil

Funding: Agency for Healthcare Research and Quality

This study assessed the impact of ACA Medicaid expansions on access to and utilization of community health center services. The project was one of the first to examine changes in access to healthcare services and to Medicaid expenditures following ACA among a large population of safety-net clinic patients.

Assessing Community Cancer care after insurance ExpanSionS (ACCESS)

PI: Jennifer E DeVoe, MD, DPhil

Funding: National Cancer Institute

This study assessed cancer screening, prevention, and survivor care among underserved populations immediately after the ACA Medicaid expansions, and followed these patients for several years after this landmark health policy natural experiment.

Post ACA Reform: Evaluation of community health center care of diabetes (PREVENT-D)

PI: Nathalie Huguet, PhD

Funding: Centers for Disease Control and Prevention/ National Institute of Diabetes and Digestive and Kidney Diseases

This study measured the impact of the ACA Medicaid expansion on diabetes prevention, treatment, expenditures, and health outcomes. The study was part of the Natural EXperiments for Translation in Diabetes (NEXT-D2) network, a collaboration of research teams from eight major US institutions to provide rigorous evaluations of natural experiments that guide the evolution of policies and programs to improve diabetes care and prevention.

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