Although the Affordable Care Act led to the largest ever expansion of Medicaid, several states decided not to expand eligibility due to a US Supreme Court Decision, explains Sameed Ahmed M. Khatana, MD, MPH. “There has been much debate regarding further expansion of Medicaid as well as changes to eligibility criteria,” he adds. “However, much of this debate has not included actual data regarding the impact of Medicaid expansion on serious health outcomes.” Given that cardiovascular disease has a higher prevalence among the uninsured, Dr. Khatana and colleagues sought to investigate whether Medicaid expansion may have been associated with differences in cardiovascular mortality rates.

For a study published in JAMA Cardiology, the researchers compared trends in cardiovascular mortality rates in the expansion states with non-expansion states, before and after expansion of Medicaid, focusing their analysis on adults aged 45 to 64 year olds) as this population was impacted by Medicaid and has a higher burden of cardiovascular disease compared to younger adults. The study used a longitudinal, observational design, using a difference-in-differences approach with county-level data from counties in 48 states (excluding Massachusetts and Wisconsin) and Washington, DC, from 2010 to 2016. Data were analyzed from November 2018 to January 2019.

When compared with counties in Medicaid non-expansion states, those in expansion states experienced a greater decrease in the percentage of uninsured residents at all income levels (mean 7.3% vs 5.6%) and in low-income strata (19.8% vs 13.5%) between 2010 and 2016. Counties in expansion states also experienced smaller changes in cardiovascular mortality rates (146.5 to 164.4 deaths per 100,000 residents per year vs 176.3 to 180.9, respectively). “Our main finding was that Medicaid expansion was associated with 4.3 fewer deaths per 100,000 residents per year from cardiovascular causes in states that expanded coverage compared with if those states had followed the same trends as those that did not expand coverage,” says Dr. Khatana. “That translates to roughly 2,000 fewer deaths per year.”

According to Dr. Khatana, as states and policymakers debate further changes to Medicaid, results of studies such as this one should be considered. “Physicians should be aware that the health policy debates that are happening in our county can have real impact to the health and wellness of their patients,” he says.


Association of Medicaid Expansion With Cardiovascular Mortality