The impact of the affordable care act (ACA) Medicaid Expansion on access to minimally invasive surgical care

Eguia, Emanuel; Baker, Marshall S.; Chand, Bipan; Sweigert, Patrick J.; Kuo, Paul C.

doi:10.1016/j.amjsurg.2019.07.003

Cited by 12 publications

(3 citation statements)

References 25 publications

(34 reference statements)

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“…Previous studies on the impact of the ACA expansion on cancer surgery have demonstrated increased rates of surgical intervention in lung and colorectal populations following the ACA expansion. 12-14 Our study demonstrated increased utilization of MIS approaches in ACA expansion states, but not due to the ACA implementation per se. One potential reason for this difference is that these states had already worked to improve access to care in ways other than the ACA.…”

Section: Discussionmentioning

confidence: 58%

The Impact of Disparities on Minimally Invasive Esophagectomy After the 2014 Affordable Care Act Expansion: A Retrospective Analysis

Badrinathan,

Syphan,

Bassiri

et al. 2023

Foregut: The Journal of the American Foregut Society

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The effect of Affordable Care Act Medicaid expansion on access to minimally invasive esophagectomy (MIE) is unknown. We hypothesize that greater Medicaid coverage resulting from ACA expansion would be associated with improved access to MIE, and performed an analysis of the National Cancer Database, comparing MIE rates in Medicaid expansion states to non-expansion states. MIE was more common in expansion states (30.37%vs 23.88%, P < .001). A multivariable difference-in-differences analysis, however, suggested no effect in MIE rate due to Medicaid expansion. This finding suggests that access to care is more complex than access to insurance. Further study is required to characterize disparities in access to MIE.

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Section: Discussionmentioning

confidence: 58%

The Impact of Disparities on Minimally Invasive Esophagectomy After the 2014 Affordable Care Act Expansion: A Retrospective Analysis

Badrinathan,

Syphan,

Bassiri

et al. 2023

Foregut: The Journal of the American Foregut Society

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“…10 Nevertheless, some studies have reported fewer substantial changes in racial health disparities following the ACA, possibly due to regional variations in its implementation. 11,12 Furthermore, studies have concluded that potentially eligible Black and Hispanic patients were less likely to be referred to a bariatric surgeon. Additionally, these patients may be excluded from surgical evaluation for not meeting presurgical lifestyle modification requirements.…”

Section: Discussionmentioning

confidence: 99%

Utilization and Outcomes of Roux-en-Y Gastric Bypass Surgery Following the Affordable Care Act in the United States

Weldeslase,

Akinyemi,

Keeling

et al. 2024

The American Surgeon™

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Background The passage of the Affordable Care Act (ACA) in 2010 marked a pivotal moment in American health care policy, significantly expanding access to health care services. This study aims to explore the relationship between the ACA and the utilization and outcomes of Roux-en-Y Gastric Bypass (RYGB) surgery. Methods Using data from the National Inpatient Sample (NIS) Database, this retrospective study compares the pre-ACA period (2007-2009) with the post-ACA period (2017-2019), encompassing patients who had RYGB. Multivariable logistic analysis was done accounting for patient’s characteristics, comorbidities, and hospital type. Results In the combined periods, there were 158 186 RYGB procedures performed, with 30.0% transpiring in pre-ACA and 70.0% in the post-ACA. Post-ACA, the proportion of uninsured patients decreased from 4.8% to 3.6% ( P < .05), while Black patients increased from 12.5% to 18.5% ( P < .05). Medicaid-insured patients increased from 6.8% to 18.1% ( P < .05), and patients in the poorest income quartile increased from 20% to 26% ( P < .05). Patients in the post-ACA period were less likely to have longer hospital stays (OR = .16: 95% CI .16-.17, P < .01), in-hospital mortality (OR = .29: 95% CI .18-.46, P < .01), surgical site infection (OR = .25: 95% CI .21-.29, P < .01), postop hemorrhage (OR = .24: 95% CI .21-.28, P < .01), and anastomotic leak (OR = .14: 95% CI .10-.18, P < .01) than those in the pre-ACA period. Discussion Following the implementation of the ACA, utilization of bariatric surgery significantly increased, especially among Black patients, Medicaid beneficiaries, and low-income patients. Moreover, despite the inclusion of more high-risk surgical patients in the post-ACA period, there were better outcomes after surgery.

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“…We observed an overall 17% increase in elective spine surgical volume, similar to rate changes found in studies that evaluated major general surgery procedures such as gastric bypass surgery (8%), paraesophageal hernia or reflux disease surgery (17%), cancer surgical procedures (12%), hernia repair (16%), and vascular surgery (20%). 8,[32][33][34] Although each of these conditions differs with regard to the urgency of treatment and the likely unmet demand among uninsured patients, the impact of Medicaid expansion was similar. These findings suggest that observed changes in procedural volume may partly reflect the degree to which surgeons balance new Medicaid demand with maintaining privately insured volumes, a tradeoff that appears to bear similarity across a variety of major health conditions.…”

Section: Discussionmentioning

confidence: 99%

Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care

Greenberg

Brown²,

Olsen

et al. 2022

Journal of Neurosurgery: Spine

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OBJECTIVE The Affordable Care Act expanded Medicaid eligibility in many states, improving access to some forms of elective healthcare in the United States. Whether this effort increased access to elective spine surgical care is unknown. This study’s objective was to evaluate the impact of Medicaid expansion under the Affordable Care Act on the volume and payer mix of elective spine surgery in the United States. METHODS This study evaluated elective spine surgical procedures performed from 2011 to 2016 and included in the all-payer State Inpatient Databases of 10 states that expanded Medicaid access in 2014, as well as 4 states that did not expand Medicaid access. Adult patients aged 18–64 years who underwent elective spine surgery were included. The authors used a quasi-experimental difference-in-difference design to evaluate the impact of Medicaid expansion on hospital procedure volume and payer mix, independent of time-dependent trends. Subgroup analysis was conducted that stratified results according to cervical fusion, thoracolumbar fusion, and noninstrumented surgery. RESULTS The authors identified 218,648 surgical procedures performed in 10 Medicaid expansion states and 118,693 procedures performed in 4 nonexpansion states. Medicaid expansion was associated with a 17% (95% CI 2%–35%, p = 0.03) increase in mean hospital spine surgical volume and a 23% (95% CI −0.3% to 52%, p = 0.054) increase in Medicaid volume. Privately insured surgical volumes did not change significantly (incidence rate ratio 1.13, 95% CI −5% to 34%, p = 0.18). The increase in Medicaid volume led to a shift in payer mix, with the proportion of Medicaid patients increasing by 6.0 percentage points (95% CI 4.1–7.0, p < 0.001) and the proportion of private payers decreasing by 6.7 percentage points (95% CI 4.5–8.8, p < 0.001). Although the magnitude of effects varied, these trends were similar across procedure subgroups. CONCLUSIONS Medicaid expansion under the Affordable Care Act was associated with an economically and statistically significant increase in spine surgery volume and the proportion of surgical patients with Medicaid insurance, indicating improved access to care.

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The impact of the affordable care act (ACA) Medicaid Expansion on access to minimally invasive surgical care

Cited by 12 publications

References 25 publications

The Impact of Disparities on Minimally Invasive Esophagectomy After the 2014 Affordable Care Act Expansion: A Retrospective Analysis

The Impact of Disparities on Minimally Invasive Esophagectomy After the 2014 Affordable Care Act Expansion: A Retrospective Analysis

Utilization and Outcomes of Roux-en-Y Gastric Bypass Surgery Following the Affordable Care Act in the United States

Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care

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