Study finds fewer heart disease-related deaths in states with Medicaid expansion

The American Heart Association reports a reduction in heart disease deaths since Medicaid expansion. (Bryan Brandenburg/CC by-SA 3.0)

There are fewer heart disease related-deaths in states that expanded Medicaid coverage under the Affordable Care Act, according to new research. 

The study, which was presented at the American Heart Association’s Quality of Care and Outcomes Research Sessions last week, focuses on the Medicaid population, as there is a higher prevalence of cardiovascular disease and other risk factors in the uninsured population. Therefore, researchers set out to see if gaining health insurance through Medicaid expansion actually helped improve outcomes in lower income populations. 

The study found that states with Medicaid expansion had four fewer deaths per every thousand residents from heart disease, which is about 1,800 fewer deaths per year. Counties with more residents living in poverty seemed to benefit the most from Medicaid expansion. Conversely, counties with the smallest increases in insurance coverage during those six years had the largest increase in cardiovascular-related deaths. 

“Although it was somewhat surprising to see a divergence in mortality rates so soon after Medicaid expansion, similar results have been seen in some other studies evaluating the association of Medicaid expansion with health outcomes,” Sameed Khatana, M.D., a fellow at the University of Pennsylvania and the study's lead author, told FierceHealthcare.

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The study used data from the Centers for Disease Control and Prevention from between 2010 and 2016. As of 2016, 29 states and the District of Columbia had expanded Medicaid options, covering 1,960 counties. Data from Massachusetts and Wisconsin were excluded as they expanded Medicaid separately from the ACA.

Khatana noted that while the study is not able conclude which mechanisms were responsible for the association of Medicaid expansion and reductions in deaths, the stronger association in the counties that had a greater number of people gaining health insurance suggests insurance coverage was playing a role. 

“Prior studies have shown higher rates of use of cardio-protective medications like aspirin, better diabetes management and higher rates of cardiac bypass surgeries associated with Medicaid expansion. All of these could potentially be playing a role,” he said. 

Looking forward, Khatana notes that policies which maximize the number of people, particularly lower income individuals, who have access to preventive care—such as those recommended in the newly released American College of Cardiology/American Heart Association Guideline on the Primary Prevention of Cardiovascular Disease—are very important.

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“We believe that studies like ours, which aim to quantitatively analyze health policies, are very important for physicians, patients as well as policy makers, particularly in the setting of the ongoing national debate about Medicaid expansion,” Khatana said.