CRN increased over time before Affordable Care Act (ACA) implementation (from 18.6% [95% CI, 16.5%-20.9%] in 2000-2005, to 22.6% [95% CI, 19.7%-25.9%] in 2006-2010, to 23.8% [95% CI, 20.7%-27.3%] in 2011 to 2013 and decreased after ACA implementation (to 18.1% [95% CI, 15.4%-21.3%]; P = .01) in 2014-2016. Data from National Center for Health Statistics.6