How Medicaid Expansion Impacts Cardiovascular Health

Sameed Khatana, MD, MPH

Medicaid expansion was associated with lower cardiovascular mortality in some adults, according to a new study published in In JAMA Cardiology.

The study is observational but uses a “quasi-experimental” approach which attempts to isolate the impact of Medicaid on cardiovascular mortality. Lead study author Sameed Khatana, MD, MPH, fellow, Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues used the Medicaid expansion states as the “treatment” group and the non-expansion states as the “control” group. They then compared these two groups from 2010 to 2016.

As of 2016, 29 states and Washington, DC had expanded Medicaid eligibility, while 19 states had not (excluding Massachusetts and Wisconsin, due to non-ACA related Medicaid expansion).

“Our main finding was that in states that expanded Medicaid, cardiovascular mortality rates for middle-aged adults [aged 45-64] stayed stable after expansion, while in non-expansion states, mortality actually increases,” says Khatana.

Related: Studies Suggest ACA Helps with Healthcare Disparities

The researchers found that expansion states had 2,000 fewer deaths per year from cardiovascular causes (among middle aged adults) after expansion, compared to if they had followed the same trends as non-expansion states.

“Medicaid expansion has had a major impact on the amount of uncompensated care provided by hospitals,” says Khatana, who is also associate fellow, Leonard Davis Institute of Health Economics at the University of Pennsylvania. “Our findings highlight how access to care, as paid for by Medicaid, appears to have had a positive impact on the cardiovascular health of people.”

The researchers also found that the association between Medicaid expansion was stronger in areas that had more poor residents, as well as in areas that had a greater increase in the number of people who gained insurance coverage after 2014.

The abstract for the paper was presented at the American Heart Association Quality of Care and Outcomes Research conference in April 2019.