Insured status, cardiac care improved after state participation in Medicaid expansion
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Key takeaways:
- The 2010 Affordable Care Act extended Medicaid to adults with incomes up to 138% of the federal poverty level.
- Participating states had improved rates of CVD preventive care and cardiac health.
Within participating states, Medicaid expansion improved insurance coverage and CV health and reduced disparities in care, according to a meta-analysis.
A provision of the Affordable Care Act of 2010 extended Medicaid eligibility to adults with incomes of up to 138% of the federal poverty level, and in 2012, the U.S. Supreme Court ruled that the decision would be left to individual states whether to participate in the expansion, according to the study background.
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As of June, individuals living in participating states with income less than $14,580 per year — or a family of four making less than $30,000 — have access to health coverage via Medicaid.
Medicaid expansion ‘improved uptake in preventive care’
“Overall, it appears that expansion of Medicaid was associated with increased health insurance coverage for individuals with heart disease and improved uptake in preventive care such as screening for health concerns that impact heart health,” Healio | Cardiology Today Editorial Board Member Jason H. Wasfy, MD, MPhil, associate professor of medicine at Harvard Medical School and director of outcomes research at the Massachusetts General Hospital Heart Center, said in a press release. “What is less clear is whether Medicaid expansion improved outcomes in hospital settings. Perhaps when patients are in the hospital, they tend to get recommended therapies regardless of insurance status, but then later, as outpatients without insurance, they may have many more difficulties in terms of accessing care.”
Wasfy and colleagues identified 30 studies published from 2014 to July 2022 that evaluated the relationship between state participation in Medicaid expansion and cardiac outcomes.
“Expansion of Medicaid is one of the most important health policy changes over the past 10 to 15 years,” Wasfy said in the release. “Many groups have studied Medicaid expansion and how it has affected the care of patients with heart disease, yet there was a need to synthesize results and resolve any discrepancies among study findings, which is what we intended to do with this paper.”
Change in cardiac care after Medicaid expansion
The median time after Medicaid expansion studied in the included analyses was 2 years across 23 participating states.
Outcomes of interest included change in insurance coverage and treatment utilization, CV-related morbidity/mortality, disparities in care, and preventive care, such as screening for and treatment of hypertension, hyperlipidemia, diabetes and obesity.
Among studies that assessed change in each of these individual outcomes after Medicaid expansion:
- 64.3% observed improved insurance coverage and treatment utilization and 35.7% observed no change;
- 36.4% observed improvement in CV-related morbidity/mortality and 63.6% observed no change;
- 37.5% observed improvement in disparities in care and 62.5% observed no change; and
- 47.8% observed improvement in preventive care and 52.2% observed no change.
None of these studies indicated any worsening of these variables after state participation in Medicaid expansion.
“Our work adds to the growing body of evidence supporting the idea that expanding health insurance coverage results in better health outcomes,” Ginger Y. Jiang, MD, MBA, clinical fellow in cardiovascular medicine at Beth Israel Deaconess Medical Center, said in the release. “As a result, it is important for health care professionals, researchers and legislators to work together to develop policies that prioritize broadening insurance coverage to improve health for all people in America.”
Reference:
- Wider access to health insurance via Medicaid expansion improved cardiac care. newsroom.heart.org/news/wider-access-to-health-insurance-via-medicaid-expansion-improved-cardiac-care. Published June 20, 2023. Accessed June 21, 2023.
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