Impact of Medicaid Expansion on Liver-Related Mortality

Patients Hospitalized for Complications of Cirrhosis may Have Benefited From Medicaid Expansion Under the Affordable Care Act

“… 14 The rate of severe sepsis, another quality measure, was also lower in the E states. Thus, on the basis of this study and the previous study, which reported lower mortality, 5 patients with cirrhosis may have benefited from ACA, which is associated with increased insurance coverage provided by the expansion of Medicaid. This benefit is not attributable to increased access to HCV antiviral treatment because access to pre- and post-Medicaid expansion was similar in the pairs Mississippi -Arkansas and Colorado-Kansas but higher in Wisconsin (NE state) than in Michigan (E state).…”

“… 4 A recent study found substantial association between Medicaid expansion and decrease in liver-related mortality. 5 However, patient characteristics associated with lower mortality and hospitalization outcomes were not addressed clearly in the study.…”

Association of State Medicaid Expansion Status With Rates of Suicide Among US Adults

“… 16 Similarly, early data have also shown associations between Medicaid expansions under the ACA and decreased mortality overall and from cardiovascular, cancer, and other causes. 17 , 18 , 19 , 20 , 21 , 22 Despite significant findings of the mortality-related benefits of Medicaid expansion, data related to the effect on mental health–related mortality remain limited. A recent study 23 that included 8 Medicaid expansion states compared with 7 nonexpansion states demonstrated a modest trend between expansion and improved suicide mortality (1.2 fewer suicides per 100 000 individuals; 95% CI, −2.5 to 0.1), although those findings were not statistically significant.…”

Medicaid Expansion Association With End‐Stage Liver Disease Mortality Depends on Leniency of Medicaid Hepatitis C Virus Coverage

“…The CDC WONDER “Multiple Cause of Death” database was queried for patients with any of the following ESLD International Classification of Diseases (ICD), Tenth Revision codes listed on their death certificates as the “underlying cause of death”: ESLD or cirrhosis (K74.4, secondary biliary cirrhosis; K74.5, biliary cirrhosis unspecified; K74.6, other and unspecified cirrhosis of liver; K70.3, alcohol‐related cirrhosis of liver; K71.7, toxic liver disease with fibrosis and cirrhosis of liver), hepatic failure (K72, hepatic failure not elsewhere classified; K70.4, alcoholic hepatic failure), and hepatocellular carcinoma (C22.0, liver cell carcinoma—malignant neoplasm). Although we recognized that running analyses strictly for HCV would likely miss many patients because the “underlying cause of death” is usually coded as a broader diagnosis (such as cirrhosis or ESLD), ( 19 ) we also assessed ESLD deaths from HCV and alcohol‐related liver disease (ALD) codiagnosis (HCV + ALD). To do this, we included ICD codes K70 (ALD) and either B17.1 (acute hepatitis C) or B18.2 (chronic hepatitis C) as secondary causes of death.…”