Coronary revascularization in Michigan more accessible, equally effective after Medicaid expansion

The expansion of Medicaid eligibility in Michigan allowed more patients to get coronary revascularization procedures without negatively affecting patient outcomes, suggests a research letter published in the Journal of the American College of Cardiology.

"Despite the concern among some that Medicaid patients may be sicker than those with Medicare or private insurance and therefore at higher risk of poor outcomes, quality of care for cardiovascular procedures across Michigan was unchanged following Medicaid expansion,” lead author Donald Likosky, PhD, associate professor of cardiac surgery at the University of Michigan, said in a press release.

The researchers studied outcomes related to 7,558 coronary artery bypass grafting (CABG) operations and 45,183 percutaneous coronary interventions (PCIs) encompassing two years before and two years after Medicaid expansion. Dubbed the “Healthy Michigan Plan,” the expansion provides coverage through Medicaid to adults with incomes up to 138 percent of the federal poverty level.

After the plan was implemented, there was a 103.8 percent increase in Medicaid patients presenting for CABG and a 44.5 percent increase in Medicaid patients presenting for PCI. Meanwhile, uninsured patients presenting for those procedures dropped by 59.6 percent and 53.2 percent, respectively.

Outcomes were similar across a range of metrics throughout the study period, despite the policy change.

“For both CABG and PCI, Medicaid expansion was not significantly associated with mortality, acute kidney injury, or length of stay, and there was no significant effect modification by insurance coverage,” the authors wrote. “(In-hospital) mortality was similar before and after expansion for CABG (0.95 percent vs. 1.03 percent) and PCI (1.07 percent vs. 0.98 percent), including among Medicaid patients undergoing CABG (1.27 percent vs. 1.31 percent) and PCI (1.63 percent vs. 1.35 percent). Finally, expansion was not associated with significant changes in appropriateness for PCI (before: 88 percent; after: 91 percent) or CABG (before: 89 percent; after: 90 percent), and similar patterns were seen across payers.”

Co-author Hitinder Gurm, MD, an interventional cardiologist at Michigan Medicine said the data is a “win-win” for Michigan residents and hospitals.

"Coronary artery disease that's severe enough to require revascularization can be a huge stress for patients, both personally and financially," he said. "Before Michigan's Medicaid expansion, more people had to manage the challenges of getting care in the uninsured setting. The new process suggests the patients are getting good care and have access to ongoing care."

According to the Kaiser Family Foundation, 32 states plus Washington, D.C., have adopted Medicaid expansion through the Affordable Care Act. However, the researchers noted there is variability in terms of the quality of data states have reported following the switch. This highlights the importance of collaborative registries such as the ones the researchers used to glean statewide information on CABG and PCI procedures, Likosky said.