Decline in uninsured hospitalizations for cardiovascular events after ACA Medicaid expansion

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Bottom Line: Medicaid expansion under the Affordable Care Act (ACA) was associated with a decline in the proportion of uninsured hospitalizations for major cardiovascular events such as heart attack, stroke and heart failure.

Why The Research Is Interesting: Cardiovascular disease is the leading primary hospital discharge diagnosis and the most common cause of death in the United States. This study examined how state decisions about whether to expand Medicaid under the ACA were associated with changes in uninsured hospitalizations for these major cardiovascular events.

What and When: More than 3 million non-Medicare hospitalizations between 2009 and 2014 from inpatient databases in 30 states (17 expanded Medicaid; 13 didn’t)

What (Study Measures and Outcomes): State Medicaid expansion as of January 2014 (exposure); comparison of the average payer mix proportions (uninsured, Medicaid, and privately insured) and in-hospital mortality between expansion and nonexpansion states before the ACA Medicaid expansion (2009-2013) and in the year (2014) after the expansion (outcomes)

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Ehimare Akhabue, M.D., of the Northwestern University Feinberg School of Medicine, Chicago, Illinois, and co-authors

Study Limitations: Total number of hospitalizations for cardiovascular events could have been underestimated; data were only available for one year after ACA implementation; and only 30 states were included in the analysis

Related Material: The invited commentary, “Medicaid Expansion and In-Hospital Cardiovascular Mortality: Failure or Unrealistic Expectations,” by Rishi K. Wadhera, M.D., M.Phil., of Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, and Karen E. Joynt Maddox, M.D., M.P.H., of the Washington University School of Medicine in St. Louis, Missouri, also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.1296)

Editor’s Note: The article contains funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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