Professor Wins Outstanding Dissertation Award.

Sarah Gordon, assistant professor of health law, policy & management, has received the 2020 Outstanding Dissertation Award by AcademyHealth. She accepted the award during a session at the organization’s virtual Annual Research Meeting (ARM) on July 30.

Titled “Continuity of Health Insurance under the Affordable Care Act: Evidence from Public and Private Markets in Colorado and Utah,” Gordon’s dissertation evaluates the stability of health insurance coverage under the ACA’s two major insurance expansions—Medicaid and the individual Marketplaces—and it is the first body of research that assesses multiple all-payer claims databases (APCDs) to measure transition rates between public and private insurance markets. Gordon completed her dissertation in 2019 at Brown University School of Public Health, where she earned a PhD in health services research, before becoming a faculty member at the School of Public Health in August 2019.

In addition to the Dissertation Award, the third chapter of Gordon’s dissertation, titled “Effects of Medicaid Expansion on Postpartum Coverage and Outpatient Utilization: Evidence from Colorado and Utah” was named Best of the Annual Research Meeting by AcademyHealth in the Coverage and Access theme, and Gordon will present her findings on postpartum coverage during an ARM plenary session on August 5.

Gordon’s full dissertation highlights the importance of evaluating continuity of insurance coverage, rather than insurance rates, to determine whether people have adequate access to the care they need to live long and healthy lives.

Although the ACA coverage expansions drastically reduced the number of Americans who are uninsured, “insurance rates depict only a snapshot in time and do not capture the dynamic nature of health insurance,” says Gordon. “Americans move in and out of different types of health insurance many times throughout their lifetimes, and the full benefits of health insurance can only be realized when coverage is continuous” to account for emergencies and ongoing access to care, she says.

Furthermore, research has shown that gaps in insurance do occur, particularly for low-income Americans who have unstable employment or whose income and eligibility for public insurance programs varies.

To date, APCDs are the only administrative data source that tracks individuals through insurance switches—but they are only available at the state level, and not all states utilize them, Gordon says. “My study achieved a novel data innovation because I combined two APCDs from neighboring states, Colorado and Utah, which enabled the assessment of enrollment and utilization outcomes across multiple payers,” she says. Colorado opted to expand Medicaid under the ACA in 2014, while Utah only recently expanded the program.

In her research, Gordon found that from 2014 to 2016, 25 percent of Colorado enrollees dropped out of the individual Marketplace, and that cost-sharing reduction payments were associated with lower disenrollment. She also found that Medicaid expansion was associated with greater stability of Medicaid coverage for people who were eligible for Medicaid prior to the expansion.

“After the expansion, Medicaid enrollees in Colorado were 16 percentage points less likely to experience a coverage disruption in a given year relative to enrollees in Utah,” she says.

Her findings also show that Medicaid expansion in Colorado was associated with improved postpartum Medicaid retention and increased use of postpartum utilization of outpatient care.

“Use of postpartum outpatient care increased nearly 50 percent among women who experienced severe maternal morbidity at the time of delivery, demonstrating that there are important access benefits of expansion for women at the highest risk of postpartum morbidity and mortality,” she says.

Gordon says her research suggests that states that did not expand Medicaid should do so to increase stability of coverage and access to postpartum care. In the individual Marketplaces, policy approaches such as reinstating the individual mandate, reinstating cost-sharing reduction payments to insurers, and increasing premium subsidies would also be effective, she says.

Coincidently, Gordon began the work for her dissertation on Brown’s campus in Providence, RI, but her family made an unexpected move to Utah for the final year of her program in 2018—the same year that the state voted to expand Medicaid.

“It could not have been a more serendipitous or timely move,” says Gordon, who was able to provide policy and economic analysis support to health policy organizations, and was invited to testify at a legislative hearing about the ballot initiative on Medicaid expansion. “Connecting in a real-world way with the policies and communities I was studying was the highlight of my doctoral experience.”

—Jillian McKoy