Study links Medicaid expansion to improved access to high-quality surgical care 

Medicaid expansion may have led to better access to high-quality surgical care, a new study found. (Getty/juststock)

Medicaid expansion may have improved patients' access to timely and high-quality surgical care, according to a new study. 

Researchers at the Harvard T. H. Chan School of Public Health analyzed trends in surgical care access and quality prior to the Affordable Care Act instituted Medicaid expansion, between 2010 and 2013, and after the coverage expansions went into effect, from 2014 to 2015.  

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They found a 1.8% increase in the likelihood that people would receive surgical care before complications occur, and a 2.6% increase in the likelihood that they'd get optimal care, according to a study published in JAMA Surgery. The study included data on more than 293,000 patients treated in 42 states for one of five common surgical conditions: appendicitis, cholecystitis, diverticulitis, peripheral artery disease or aortic aneurysm. Of those patients, more than 225,000 were in expansion states and nearly 68,000 were in nonexpansion states. 

"What was most striking was that we saw significant improvements in the treatment of surgical conditions fairly quickly, less than two years after states expanded Medicaid coverage," Andrew Loehrer, M.D., a research fellow at Harvard and the study's lead author, said in an announcement

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The study also found a 7.5% increase in the likelihood that patients in expansion states were insured, and an 8.6% increase in the likelihood that they were enrolled in Medicaid.

The Harvard researchers did not uncover a definite reason for the study's findings, but theorized that because more people gained insurance coverage under expanded Medicaid, they were more likely to seek out treatment for these conditions before they became severe. 

Another study, published Wednesday in Health Affairs, linked Medicaid expansion to a 4.5% decrease in the probability that a person making between 100% and 138% of the federal poverty level would be uninsured.

Medicaid expansion has also changed the payer mix in emergency departments and primary care practices, reducing the number of uninsured people treated in both settings. Research has also suggested that expanded Medicaid enrollment improved access and eased medical debt burdens for low-income patients.

The Health Affairs study, which was based on data from the Census Bureau's Current Population Survey and the American Community Survey, found that Medicaid expansion was associated with a decrease in out-of-pocket spending for these patients. The study showed a 4.1% drop in high-burden out-of-pocket spending between 2010 and 2015 in expansion states, and a 7.7% decrease in the likelihood of having any out-of-pocket spending relative to nonexpansion states.  

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Benjamin Sommers, M.D., Ph.D., associate professor of health policy and economics at the Chan School, said in the announcement that research like this should inform lawmakers looking to make national health policy changes. 

"Our findings provide important new evidence that Medicaid expansion is improving the quality of care for serious conditions affecting tens of thousands of Americans each year," Sommers said.