The expansion of Medicaid under the Affordable Care Act (ACA) has increased the likelihood that low-income Americans are undergoing major surgery early, before they develop serious complications, according to a study published Wednesday in JAMA Surgery. 

The ACA’s Medicaid expansion has also made it more likely that those patients will receive the best care possible, the study found.

“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,” said lead author Dr. Andrew Loehrer, in a released statement. Now a surgical oncologist at the M.D. Anderson Cancer Center in Texas, Loehrer conducted the study while a research fellow at Harvard University in Boston.

Surveys have previously shown that the ACA’s Medicaid expansion increased Americans’ access to primary care and medications, as well as their perceptions of their overall health. This is the first study, however, to show that the expansion has had a positive effect on medical outcomes for low-income people needing surgery for serious medical conditions.

As background information in the study points out, when people are uninsured or underinsured they are significantly more likely to delay seeking care for a wide range of medical conditions, including serious ones. And when they are diagnosed with a serious condition, they are less likely to receive the best available care.  People who are uninsured or underinsured tend to have to wait longer to have surgery for an inflamed gall bladder (cholecysitis), for example, and they are more likely to have a leg amputated after a diagnosis of peripheral artery disease (PAD). 

Medicaid expansion has helped reduce those disparities, the new study found.

Study details

For the study, Loehrer and his colleagues analyzed five years of data (2010-2015) from almost 300,000 patients, aged 18 to 64, who were hospitalized in the United States with one of five common surgical conditions: appendicitis, cholecystitis, diverticulitis, aortic aneurysm or PAD.

The researchers said they focused on these conditions because “they are typically urgent conditions that require prompt evaluation, delays in care may respond quickly to changes in health insurance status, and they are highly costly and morbid conditions.”

The data came from 272 hospitals: 203 were located in 27 states that expanded their Medicaid programs after ACA and 69 were in 15 states that didn’t. 

The study found that Medicaid expansion was associated with the following:

• a 7.5 percent decrease in the probability that patients arriving at a hospital with one of the five serious surgical conditions were uninsured;
• an 8.6 percent increase in the probability that the patients had Medicaid;
• a 1.8 percent increase in the probability that the patients had sought care early in the progression of their disease; and
• a 2.6 percent increase in the probability that the patients received the best care possible.

Earlier care, fewer complications

The researchers say their findings are likely explained by several key factors.

“Newly insured individuals may be less likely to delay seeking care and thus present sooner when early symptoms develop,” they point out. Early care increases the chances for optimal treatment — and improved outcomes, they add.

“In addition, hospitals may be more willing to provide care for newly insured individuals who previously lacked coverage,” the researchers write.

“The fate of the ACA and Medicaid remains a key policy debate,” said Benjamin Sommers, the study’s senior author and an associate professor of health policy and economics at Harvard University, in the released statement. “As policymakers continue to discuss major changes to the ACA, and the Trump administration advances reforms that could lead to fewer people covered by Medicaid, our findings provide important new evidence that Medicaid expansion is improving the quality of care for serious conditions affecting tens of thousands of Americans every year.”

FMI:  The study can be downloaded and read at JAMA Surgery’s website.