Rate of Uninsured AMI Patients Decreased After Medicaid Expansion, NCDR Study Finds

States that expanded Medicaid eligibility as part of the Affordable Care Act experienced a significant decrease in the number of uninsured patients hospitalized for acute myocardial infarction (AMI), according to a study published Jan. 16 in JAMA Cardiology.

Rishi K. Wadhera, MD, MPP, et al., used data from ACC's Chest Pain – MI Registry to assess whether uninsurance rates, quality of care and outcomes among hospitalized AMI patients changed in states that expanded Medicaid vs. those that did not. The researchers looked at trends in insurance status before and after Medicaid expansion in an initial cohort of 325,343 AMI patients younger than age 65. A separate low-income cohort of 55,737 low-income patients who were either uninsured or insured through Medicaid during hospitalization was used to compare quality of care, procedure use, and outcomes pre- and post-Medicaid expansion.

According to the results, the rate of uninsured AMI hospitalizations decreased from 18 percent before expansion to 8.4 percent post-expansion. States that did not expand Medicaid experienced a smaller decrease – 25.6 percent pre-expansion to 21.1 percent post-expansion. The number of patients with Medicaid coverage rose to 14.4 percent from 7.5 percent in expansion states vs. an increase to 6.6 percent from 6.2 percent in nonexpansion states.

Researchers measured quality of care using the defect-free care measure, which increased slightly in both expansion states (76.3 percent pre-expansion vs. 75.9 percent post-expansion) and nonexpansion states (72.8 percent pre-expansion vs. 74.5 percent post-expansion). There was no change in the frequency of procedures such as PCI for non-STEMI patients between expansion and nonexpansion states. Finally, improvement in in-hospital mortality rates was similar for both groups, with expansion states at 3.2 percent pre-expansion and 2.8 percent post-expansion, compared with 3.3 percent and 3 percent for nonexpansion states.

The authors conclude that Medicaid expansion was associated with a significant increase in insurance rates among AMI patients, but there was little difference in quality of care or outcomes between states that expanded Medicaid vs. those that did not. They add that these findings suggest that in-hospital care for AMI patients "may be less sensitive" to a patient's insurance status than previously thought.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: National Cardiovascular Data Registries, Chest Pain MI Registry, Cohort Studies, Percutaneous Coronary Intervention, Quality of Health Care, Myocardial Infarction, Patient Protection and Affordable Care Act, Medicaid, Medically Uninsured, Hospitalization, Chest Pain


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