States that expanded eligibility for their Medicaid program in 2014, when the Affordable Care Act was implemented, saw fewer uninsured patients with major cardiac-related hospitalizations in the first year compared with states that did not expand the program, according to a study in JAMA Network Open.
One goal of the Affordable Care Act was to broaden access of healthcare coverage to low-income people by expanding Medicaid, but states were able to choose whether to extend Medicaid eligibility — potentially leading to differences in insurance coverage levels across the country for those in lower socioeconomic groups, which have been shown to experience a higher rate of cardiovascular-related and other chronic illnesses.
Led by a physician from Rutgers Robert Wood Johnson Medical School, Ehimare Akhabue, the study looked at the differences in the rate of hospitalizations for significant cardiovascular-related events of uninsured individuals before and after the implementation of the ACA.
The study found an immediate reduction in the percentage of people hospitalized without insurance, particularly among states that expanded Medicaid.
The researchers analyzed a large sample of data from the Healthcare Cost and Utilization Project State Databases, and after removing states with incomplete data, the team examined information from 30 states in total — 17 of which expanded Medicaid eligibility in 2014 and 13 of which did not — constituting nearly three-quarters of the U.S. population and more than 3 million hospitalizations during that time.
The study is believed to be one of the first to analyze the association between state-level policy regarding Medicaid expansion and changes in uninsured hospitalizations for major cardiovascular events — although prior studies found that Medicaid expansion states had, in general, seen fewer hospitalizations of individuals without insurance.
Although the team did not examine the economic outcomes of a decrease in uninsured hospitalizations in expansion states, they believe their findings could potentially have important cost implications for patients, hospitals and policymakers.