Cardiac Surgery Utilization Across Vulnerable Persons After Medicaid Expansion

Area of Science:

• Health Services Research
• Cardiovascular Surgery
• Health Policy Analysis

Background:

• The Affordable Care Act's Medicaid expansion (ME) aimed to reduce uninsurance, but its impact on vulnerable populations, particularly for essential procedures like cardiac surgery, requires further investigation.
• Previous studies show mixed results regarding ME's preferential effects on specific demographic groups.
• This study specifically examines ME's influence on cardiac surgery utilization across different insurance strata, racial groups, and income levels.

Purpose of the Study:

• To determine if Medicaid expansion preferentially improved cardiac surgery use among vulnerable populations.
• To analyze the impact of ME on cardiac surgery utilization based on insurance status, race, and income level.
• To assess disparities in cardiac surgery access following Medicaid expansion.

Main Methods:

• The study identified non-elderly adults (18-64 years) undergoing major cardiac surgeries (CABG, AVR, MVR, MV repair) in state inpatient databases.
• Data were collected from 3 ME states (KY, NJ, MD) and 2 non-expansion states (NC, FL) between 2012 and Q3 2015.
• Adjusted Poisson interrupted time series analysis was employed to evaluate ME's impact on cardiac surgery use for Medicaid/uninsured (MCD/UIS) patients, minorities, and low-income individuals.

Main Results:

• In expansion states, cardiac surgery use showed a positive trend for non-White MCD/UIS patients (2.3%/quarter) but a negative trend for White MCD/UIS patients (-1.7%/quarter), though these were not statistically significant.
• In non-expansion states, cardiac surgery use declined significantly for both non-White (-4.4%/quarter) and White (-1.8%/quarter) MCD/UIS patients.
• Medicaid expansion did not demonstrate a substantial effect on cardiac surgery use for MCD/UIS patients from low-income versus high-income areas.

Conclusions:

• Overall cardiac surgery use remained largely unchanged following Medicaid expansion.
• Nonsignificant trend differences suggest a potential narrowing of the gap in cardiac surgery use between vulnerable and non-vulnerable groups in ME states.
• Insurance coverage, influenced by Medicaid expansion, plays a role in driving cardiac surgery use among vulnerable patient populations.