Medicaid expansion brings improved cardiac care

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States that have expanded Medicaid eligibility have seen better care and improved outcomes for people with heart disease, a new study finds.

Researchers analyzed 30 studies comparing the impact of Medicaid coverage on cardiovascular care and outcomes in states that have expanded Medicaid eligibility and those that haven’t. They focused on four areas, including insurance coverage and treatment utilization, morbidity/mortality, care disparities, and preventive care. They found that:

Nearly two-thirds (64%) of the studies tracking changes in insurance coverage for cardiac treatment found improvement following Medicaid expansion.

• Slightly more than one-third (36%) of the studies tracking morbidity/mortality changes found improvements with Medicaid expansion, but no association with in-hospital deaths.
• Among the studies tracking disparities in care across socioeconomic and demographic groups, 37.5% found reduced disparities with Medicaid expansion.
• Just under 48% (47.8%) of the studies tracking preventive care, such as screening and treatment for high blood pressure and Type 2 diabetes, showed improvement with Medicaid expansion.

A provision of the 2010 Affordable Care Act required states to expand Medicaid eligibility to 138% of the federal poverty level, with the federal government initially paying the full cost of the expansion before gradually reducing its share to 90% by 2020. In 2012 the U.S. Supreme Court ruled the requirement unconstitutional but gave states the option of expanding Medicaid eligibility. To-date 41 states have done so.

“Expansion of Medicaid is one of the most important health policy changes over the past 10-15 years,” senior study author Jason H. Wasfy, M.D., M.Phil., associate professor of medicine at Harvard Medical School and director of outcomes research at the Massachusetts General Hospital Heart Center, said in an accompanying press 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.”

“Our work adds to the growing body of evidence supporting the idea that expanding health insurance coverage results in better health outcomes,” said Ginger Y. Jiang, M.D., M.B.A., a clinical fellow in cardiovascular medicine at Beth Israel Deaconess Medical Center and the study’s lead author. “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.”

The study, “Medicaid Expansion Under the Affordable Care Act and Association With Cardiac Care: A Systematic Review” was published June 20 in Circulation: Cardiovascular Quality and Outcomes, a peer-reviewed American Heart Association Journal