Study Finds Adopting ACA Medicaid Expansion Increased Heart Transplant Listings in African-Americans

The implementation of the Affordable Care Act (ACA) Medicaid Expansion was associated with increased heart transplant listings in African-Americans, according to a study published Jan. 18 in JACC: Heart Failure.

Using the Scientific Registry of Transplant Recipients, Khadijah Breathett, MD, et al., analyzed 5,651 patients from early adopter states, states that implemented the expansion by Jan. 2014, and 4,769 patients from non-adopter states from 2012 to 2015. Piecewise linear models, stratified by race and ethnicity, were fit to monthly census-adjusted rates of heart transplant listings before and after Jan. 2014.

Authors observed a 30 percent increase in the rate of heart transplant listings for African-Americans immediately following ACA Medicaid Expansion in early adopter states. In contrast, the rate of heart transplant listings for African-Americans in non-adopter states remained constant. Authors found that Hispanics experienced an opposite trend, with the rates showing no significant change in early adopter states but an increase in non-adopter states. There were no significant changes in listing rates among Caucasians in either early adopter or non-adopter states.

The authors conclude that their findings suggest that improved access to insurance may be a partial solution to reducing racial and ethnic disparities in organ allocation in the U.S.

“Because the number of donor hearts is limited, it is critical that different racial and ethnic groups have equitable access to this scarce resource,” said Breathett. “In some states, patients with basic health care coverage like Medicaid may not be given equitable candidacy as patients with Medicare and private insurance since Medicaid programs will not universally cover costs of transplantation. It is paramount to avoid increasing racial/ethnic disparities as the selection process is calibrated particularly among politically divided Organ Procurement Organizations.”

In an accompanying editorial comment, Marvin A. Konstam, MD, FACC, suggests that this progress towards eliminating disparity in heart transplant allocation should not be abandoned. He explains that, “If we achieve consensus around our core goals, then there is no escaping a role of government in subsidizing health care for our least fortunate citizens, but beyond this fact, there are other legitimate choices to make: the relative roles of the private vs. public sectors; service-based vs. value- and population-based payment models; and payer focused vs. provider- and patient-focused decision making and risk bearing.” Konstam concludes with this sentiment, “Let us hope that as this next round of the debate unfolds, it focuses less on the name of the act and more on serving the health care needs of our entire population.”


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