A new study supports the idea of Medicaid coverage improving outcomes. The study, published in The Annals of Thoracic Surgery, found that an increase in the number of patients covered by Medicaid in recent years is associated with better outcomes for heart surgery patients
Researchers analyzed data from two states: Michigan, which approved Medicaid expansion under the Affordable Care Act via a Section 1115 waiver, and Virginia, which did not expand Medicaid. The goal was to determine whether this expansion of insurance coverage would affect outcomes of patients undergoing coronary artery bypass grafts or valve operations.
They found that Medicaid expansion significantly improved the outcomes of patients who had these procedures. While the number of uninsured people and the outcomes of heart surgery patients in Virginia remained the same during the study period, in Michigan the volume of surgery patients covered by Medicaid increased by 70 percent while the uninsured surgical volume dropped by 60 percent.
More important, the patients in Michigan were 30 percent less likely to experience a major post-operation complication, such as stroke or kidney failure. “The implications are Medicaid expansion improved results,” says Irving Kron, M.D., a surgeon at University of Virginia Health System and a co-author of the study.
The patients were also likely to receive more preoperative primary care, which contributes to improved baseline health before needing an operation, says Eric Charles, M.D., a study co-author and surgical resident at UVA Health System.
“Patients appeared to do much better after becoming insured. Those who are sicker at surgery do worse after surgery,” he says.
The study additionally found that people who remained uninsured in Michigan after Medicaid expansion had worse outcomes. “If Medicaid is rolled back [I also] expect the newly uninsured patients would do worse,” says Kron.
The American Hospital Association opposes cuts to the Medicaid program, recently calling on the Senate to “go back to the drawing board” on its proposed health care bill, which, like the House bill, would roll back Medicaid expansion and leave many people without insurance.
The study highlights the need to review the Medicaid program and its expansion not just in terms of cost but in terms of actual patient health.
“Quality improvement is a daily activity [for hospitals]. Since we’re collecting really good data, we need to use it to affect policies and shift the discussion away from just cost,” Charles says.