Medicaid expansion was associated with a smaller increase in the rates of cardiovascular mortality than in places that did not expand Medicaid, a new analysis suggests.
The authors, publishing in JAMA Cardiology, looked whether the Patient Protection and Affordable Care Act, which was responsible for the largest gains in health insurance coverage for nonelderly adults in the U.S., was associated with any decrease in cardiovascular mortality. The longitudinal, observational, difference-in-difference study included county-level data from 48 states on adults aged 45 to 64 from 2010 to 2016. The research team looked specifically at annual, age-adjusted cardiovascular mortality rates from prior to the Medicaid expansion and after the expansion. A total of 29 states had expanded Medicaid eligibility and 19 did not (2 states were excluded from the study).
Counties in states that expanded Medicaid had a significantly smaller increase in cardiovascular mortality rates among middle-aged adults after expansion compared with counties in states that did not expand Medicaid. @PennLDI https://t.co/2CJ9w97yZC
— JAMA Cardiology (@JAMACardio) June 5, 2019
Expansion Improves Cardiovascular Mortality
According to the results, counties in states where there was a Medicaid eligibility expansion saw greater decreases in the percentage of uninsured residents across all income levels and in low-income strata. Counties in states with Medicaid expansions had smaller changes in the cardiovascular mortality rates compared with those who did not expand Medicaid (146.5 [95% CI, 132.4 to 160.7] to 146.4 [95% CI, 131.9 to 161.0] deaths per 100 000 residents per year versus 176.3 [95% CI, 154.2 to 198.5] to 180.9 [95% CI, 158.0 to 203.8] deaths per 100 000 residents per year in non-expansion states). After adjustment for demographics, clinical, and economic differences, counties in expansion states had 4.3 fewer deaths per 100,000 residents per year from cardiovascular causes than if they had followed non-expansion states.
“Counties in states that expanded Medicaid had a significantly smaller increase in cardiovascular mortality rates among middle-aged adults after expansion compared with counties in states that did not expand Medicaid,” the researchers wrote. “These findings suggest that recent Medicaid expansion was associated with lower cardiovascular mortality in middle-aged adults and may be of consideration as further expansion of Medicaid is debated.”
Another critical evidence element. CV mortality goes up in states that did not expand medicaid; "stable" CV mortality rates in states that did expand. @dukeforge @SecMandyCohen Association of Medicaid Expansion With Cardiovascular Mortality https://t.co/icW093aCW3
— Robert M Califf (@califf001) June 5, 2019
Important. #JAMA. Counties in states that expanded #Medicaid eligibility had a significantly smaller increase in age-adjusted #cardiovascular mortality rates among residents aged 45 to 64 years after expansion compared with counties in non-expansion states https://t.co/3WNc8ssRNX
— George Mensah, MD (@NHLBI_Translate) June 5, 2019
— Lynn Howie (@LynnHowie1) June 6, 2019