Medicaid expansion through ACA tied to fewer heart disease deaths

Counties in states that expanded Medicaid coverage under the Affordable Care Act (ACA) had fewer deaths from cardiovascular disease than those in states that didn’t expand Medicaid, according to an abstract presented April 5 at the American Heart Association’s Quality of Care and Outcomes Research scientific sessions.

By 2016, Washington, D.C., and 29 states had expanded Medicaid coverage through the ACA while 19 states had not. Massachusetts and Wisconsin expanded Medicaid through other means, so they were excluded from the study, which altogether included 1,960 U.S. counties.

Lead author Sameed Ahmed M. Khatana, MD, and colleagues sought to quantify the impact of Medicaid expansion through the ACA on cardiovascular disease mortality in adults aged 45 to 64—considering the policy led to one of the largest-ever gains in insurance coverage for nonelderly adults.  

They found that, after adjusting for demographic and economic variables, counties in expansion states had four fewer deaths per 1,000 middle-aged residents than if they’d followed the same trends of counties in non-expansion states.

During the analysis period from 2010 to 2016, cardiovascular mortality in counties from non-expansion states increased from 141.9 to 142 deaths per 100,000 population. The same measure grew from 176.1 to 180.6 deaths over that timeframe for counties in states which didn’t expand Medicaid—a significantly larger increase.

“This is one of the first large studies of its type to show that, with this round of Medicaid expansion, there might have been a population level mortality benefit for patients with cardiovascular disease,” Khatana, a fellow in cardiovascular disease at the Hospital of the University of Pennsylvania, said in a press release. “We believe these findings will be helpful for policymakers and health policy researchers in trying to tease out the impact of this most recent round of expansion.”

The analysis also found that counties in expansion states saw a 19.8% increase in health insurance coverage for low-income residents, compared to a 13.5% increase in non-expansion states. Rural areas and those with more residents living in poverty appeared to experience the greatest mortality benefit as a result of Medicaid expansion.

“We can't necessarily say from our study that giving a person health insurance through Medicaid will save their life,” Khatana said. “However, our study does show that there perhaps were at least widespread benefits concentrated in certain groups, such as those uninsured or people with higher risk of cardiovascular disease, although we can’t say for sure it was a direct result of the Medicaid expansion.”