Expansion of Insurance Under the Affordable Care Act and Invasive Management of Acute Myocardial Infarction

Medicaid Expansion Under the Affordable Care Act and Association With Cardiac Care: A Systematic Review

“…Twelve studies evaluated the relationship between Medicaid expansion and insurance coverage/treatment utilization across 14 individual and system-level outcomes. 16,[18][19][20]22,33,[36][37][38][41][42][43] Of these, insurance coverage and utilization of treatment improved in 8 studies and did not change in 4 studies. Akhabue et al 22 found that states that expanded Medicaid had a 5.8% point decrease in proportion of uninsured cardiac hospitalizations relative to nonexpansion states.…”

“…Wadhera et al 41,42 similarly demonstrated a decline in uninsured heart failure (HF) hospitalizations from 7.9% to 4.4% and uninsured hospitalizations for acute myocardial infarction (AMI) from 18.0% to 8.4%, although found no change in use of cardiac catheterization or percutaneous coronary intervention. Haimovich et al 33 compared non-Medicare with Medicare patients under the assumption that the policy effect of insurance expansion would impact only the non-Medicare group, and following propensity score adjustment similarly found no significant difference in rate AMI hospitalizations receiving percutaneous coronary intervention. In a cross-sectional analysis, Oseran et al 38 found that working-age adults with low income in expansion states had 18.6% lower rates of uninsurance compared with adults in nonexpansion states, and also were more likely to have a usual source of care and recent examination.…”