2,000 fewer peo­ple died of heart dis­ease each year in states that ex­panded Med­i­caid, Penn study finds

Lodi News-Sentinel - - PAGE TWO - By Tom Avril

PHILADEL­PHIA — Peo­ple with symptoms of a heart at­tack are less likely to visit the emer­gency room if they lack health in­sur­ance, stud­ies have found.

So in 2014, when the Af­ford­able Care Act al­lowed states to ex­pand the num­ber of res­i­dents el­i­gi­ble for Med­i­caid, that sug­gested a real-life ex­per­i­ment to a team of Univer­sity of Penn­syl­va­nia re­searchers:

Would the in­crease in in­sur­ance cov­er­age lead to a de­cline in deaths from heart at­tacks and other heart dis­ease?

An anal­y­sis of seven years of death rates in peo­ple aged 45 to 64 sug­gests the an­swer is yes, the team re­ported Wed­nes­day in the jour­nal JAMA Car­di­ol­ogy.

At a glance, the de­cline may sound mod­est — 4.3 fewer deaths per 100,000 res­i­dents per year in 29 states that were the first to ex­pand Med­i­caid, in­clud­ing Penn­syl­va­nia and New Jersey. But when that rate is mul­ti­plied by the pop­u­la­tion in those states, it trans­lates to 2,000 fewer deaths per year, the study found.

The au­thors, who col­lab­o­rated with re­searchers from Har­vard Med­i­cal School, com­pared the heart-dis­ease death rates in the four years be­fore Med­i­caid was ex­panded in those states (2010 through 2013) with the death rates in the three years after­ward.

Be­cause the num­ber of deaths from heart dis­ease in younger adults has been on the rise na­tion­wide, the re­searchers also an­a­lyzed deaths in states that did not ex­pand Med­i­caid, so the broader trend could be taken into ac­count, lead study au­thor Sameed Khatana said.

That is, the de­cline of 2,000 deaths rep­re­sents the pro­jected dif­fer­ence between re­al­ity and what would have hap­pened in those states had they not ex­panded Med­i­caid, said Khatana, a car­dio­vas­cu­lar medicine fel­low at Penn’s Perel­man School of Medicine.

“In states that didn’t ex­pand Med­i­caid, mor­tal­ity kept go­ing up,” he said. “But in states that did ex­pand Med­i­caid, mor­tal­ity stayed rel­a­tively sta­ble.”

The find­ings come as Med­i­caid ex­pan­sion is un­der fire in some states, with Repub­li­can law­mak­ers propos­ing that in order to qual­ify for the health in­sur­ance, peo­ple would need to prove that they are em­ployed, among other re­quire­ments.

States ex­panded ac­cess to Med­i­caid in a va­ri­ety of ways start­ing in 2014, gen­er­ally by rais­ing the income thresh­old at which peo­ple could qual­ify for the in­sur­ance, and also by re­mov­ing other hur­dles, such as re­quir­ing that the in­sured per­son have a dis­abil­ity.

Be­cause the Penn study was ob­ser­va­tional, the re­searchers could not show that Med­i­caid ex­pan­sion caused a de­cline in deaths from heart dis­ease, only that the two trends went hand in hand.

But on a pop­u­la­tion level, it is plau­si­ble that ex­pand­ing in­sur­ance cov­er­age could pre­vent deaths from heart dis­ease, Khatana said. Prompt treat­ment in an emer­gency room is es­sen­tial for im­prov­ing a per­son’s chance of sur­viv­ing the kinds of car­dio­vas­cu­lar prob­lems in­cluded in the anal­y­sis: heart at­tack, stroke, and sud­den car­diac ar­rest.

In ad­di­tion to de­ter­min­ing the statewide ef­fect of Med­i­caid ex­pan­sion, the study au­thors also drilled down to the county level, look­ing at the num­bers of peo­ple who ac­tu­ally signed up for the in­sur­ance.

What they found re­in­forced the find­ings on the state level, Khatana said. Coun­ties with the smallest in­creases in in­sur­ance cov­er­age had the largest in­creases in deaths from car­dio­vas­cu­lar dis­ease, the study found.


An anal­y­sis of seven years of death rates in peo­ple aged 45 to 64 sug­gests the in­crease in in­sur­ance cov­er­age with the Af­ford­able Care Act lead to a de­cline in deaths from heart at­tacks and other heart dis­ease.

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