January 16, 2019
2 min read

Medicaid expansion fails to affect acute MI outcomes

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Among low-income patients with acute MI, residing in a state with Medicaid expansion had no effect on quality of care or outcomes, according to new findings.

“In this study, we aimed to answer three questions,” Rishi K. Wadhera, MD, MPP, MPhil, from Brigham and Women’s Hospital Heart and Vascular Center and Harvard Medical School, and colleagues wrote. “First, did rates of uninsurance and Medicaid insurance change among adults hospitalized for [acute] MI after the [Affordable Care Act’s] Medicaid expansion? Second, did inpatient care quality and procedure use change for low-income patients in states that elected to expand Medicaid compared with states that did not expand? And finally, did in-hospital outcomes improve in states that expanded Medicaid compared with nonexpansion states?”

The researchers analyzed 325,343 patients younger than 65 years who were hospitalized for acute MI between 2012 and 2016 and were included in the National Cardiovascular Data Registry’s Acute Coronary Treatment and Intervention Outcomes Network registry.

During the study period, among the cohort, the rates of uninsured hospitalizations for acute MI dropped from 18% to 8.4% in expansion states and from 25.6% to 21.1% in nonexpansion states (P < .001 for difference in trend).

Meanwhile, Medicaid coverage increased from 7.5% to 14.4% of patients in expansion states and from 6.2% to 6.6% of patients in nonexpansion states (P < .001), according to the researchers.

The low-income cohort included 55,737 patients (mean age, 53 years; 71% men), of whom 30.4% were insured with Medicaid and the rest were uninsured. Among this group, during the study period, after adjustment, odds of defect-free care increased in expansion states (adjusted OR = 1.11; 95% CI, 1.02-1.21), but to a lesser degree than in nonexpansion states (aOR = 1.38; 95% CI, 1.3-1.47; P for interaction < .001), the researchers wrote.

The usage of most procedures did not change in expansion vs. nonexpansion states, they wrote.

In-hospital mortality improved in expansion states, but not to a greater degree than it did in nonexpansion states (expansion states, from 3.2% to 2.8%; aOR = 0.93; 95% CI, 0.77-1.12; nonexpansion states, from 3.3% to 3%; aOR = 0.85; 95% CI, 0.73-0.99; P for interaction = .48), Wadhera and colleagues wrote.

“These findings suggest that current care systems for urgent, time-sensitive conditions may be less sensitive to insurance than has been recognized in the past,” the researchers wrote. – by Erik Swain

Disclosures: Wadhera reports he previously consulted for Regeneron. Please see the study for all other authors’ relevant financial disclosures.