Cardiovascular Disease Utilization Grew After Medicaid Expansion

November 17, 2023 – Adults with cardiovascular disease are more likely to utilize outpatient cardiovascular services in Medicaid expansion states than in nonexpansion states, a study published in Health Affairs revealed.

The researchers used Medicaid Analytic eXtract data to assess utilization trends among nonelderly adult beneficiaries. The study timeframe started in 2012, before the Affordable Care Act went into effect, and ended in 2015. The researchers observed patterns in New Jersey and Minnesota, two states that expanded Medicaid, and Georgia and Tennessee, which did not expand.

During the pre-expansion timeframe, states that ultimately expanded their Medicaid programs saw the adjusted mean quarterly number of beneficiaries with one or more outpatient cardiovascular visits was 8.4 per every 1,000 nonelderly low-income residents. In nonexpansion states, the rate was 4.5 beneficiaries with one or more visits per every 1,000 nonelderly, low-income residents.

After expansion, the number of beneficiaries in the study population with one or more outpatient cardiovascular visits rose from 8.4 to 11.7 for every 1,000 beneficiaries in the expansion states. In contrast, the rate stayed fairly steady in nonexpansion states, increasing from 4.5 to 4.9 beneficiaries per 1,000.

Put another way, Medicaid expansion spurred a 38.1 percent growth in the rate of cardiovascular-related outpatient visits per 1,000 beneficiaries when compared to nonexpansion states, according to an adjusted negative binomial difference-in-differences model.

The rate of beneficiaries with at least two cardiovascular outpatient visits also increased in Medicaid expansion states, rising 35.4 percent compared to nonexpansion states. Additionally, more patients in Medicaid expansion states visited cardiovascular specialists (57.8 percent increase compared to nonexpansion states).

The rate of beneficiaries per quarter per 1,000 low-income, nonelderly adult beneficiaries that were prescribed cardiovascular medicine, especially the rate of beneficiaries prescribed each category of cardiovascular medication, grew significantly as well.

Hospitalizations and emergency department visits for cardiovascular diseases—as well as all-cause hospitalizations and emergency department visits—rose in Medicaid expansion states compared to nonexpansion states.

“The analysis also noted an increase in the rate of hospitalizations and ED visits. These could have resulted from either increased contact with the health care system or reduced financial concerns when beneficiaries sought care after gaining health insurance,” the researchers explained.

“However, previous studies suggest that although the proportion of ED visits in which the primary payer was Medicaid increased after expansion, with a concomitant decrease in uncompensated care, the overall volume of ED visits stayed the same.”

As expected, Medicaid expansion also had an impact on insurance rates. During the study period, Medicaid expansion increased coverage in the expansion states from 37.0 percent to 47.8 percent and in the nonexpansion states from 25.3 percent to 28.8 percent.

The findings add to previous research that indicates Medicaid expansion may lead to higher access to care for certain conditions including behavioral healthcare, reproductive healthcare, and chronic disease management.