CVD mortality rates lower in states with Medicaid expansion through ACA
The expansion of Medicaid through the Affordable Care Act was associated with a beneficial effect on CV mortality and may be an important consideration when debating increasing program eligibility, according to findings presented at the American Heart Association Quality of Care and Outcomes Research Scientific Sessions.
Sameed Ahmed M. Khatana, MD, and colleagues sought to study whether CV mortality for middle-aged adults differed between states that did and did not expand Medicaid.
“This is one of the first large studies of its type to show that, with this round of Medicaid expansion, there might have been a population-level mortality benefit for patients with cardiovascular disease,” Khatana, a fellow in cardiovascular disease at the Hospital of the University of Pennsylvania, said in a press release. “We believe these findings will be helpful for policymakers and health policy researchers in trying to tease out the impact of this most recent round of expansion.”
The researchers analyzed statistics from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) mortality database for county-level, age-adjusted, CV mortality rates for adults aged 45 to 64 years from 2010 to 2016. Data were taken from all states, excluding Massachusetts and Wisconsin, whose Medicaid expansion was not due to the ACA.
Khatana and colleagues used a differences-in-differences approach to measure difference in CV mortality rates between states based on Medicaid expansion status, before and after expansion.
The researchers compared data from counties in states that expanded Medicaid eligibility and states that did not expand coverage (n = 1,960).
Counties in expansion states had a greater increase in health insurance coverage for low-income residents compared with counties in non-expansion states (19.8% vs. 13.5%; P < .001), Khatana and colleagues wrote.
The researchers found counties in expansion states had a significantly smaller increase in CV mortality rates (from 141.9 deaths per 100,000 residents per year to 142) compared with counties in non-expansion states (from 176.1 deaths per 100,000 residents per year to 180.6).
When accounting for differences in economic and demographic variables, counties in expansion states had four fewer deaths per 100,000 residents per year from CV causes after expansion (95% CI, 2.1-6) compared with counties in non-expansion states.
“We can’t necessarily say from our study that giving a person health insurance through Medicaid will save their life,” Khatana said in the press release. “However, our study does show that there perhaps were at least widespread benefits concentrated in certain groups, such as those uninsured or people with higher risk of cardiovascular disease, although we can’t say for sure it was a direct result of the Medicaid expansion.” – by Earl Holland Jr.
Khatana SAM, et al. Presentation 3. Presented at: American Heart Association Quality of Care and Outcomes Research Scientific Sessions; April 5-6, 2019; Arlington, Va.
Disclosure: Khatana reports no relevant financial disclosures.