Heart surgery outcomes in Michigan improve 30% after Medicaid expansion, study finds

Expanded Medicaid coverage is linked to a decreased risk of major complications or mortality following heart surgery, according to a study published in The Annals of Thoracic Surgery.

Researchers, led by Eric Charles, MD, categorical general surgery resident at Charlottesville-based University of Virginia School of Medicine's department of surgery, analyzed data from heart surgery quality databases in one Medicaid expansion state — Michigan — and one nonexpansion state — Virginia. The states' respective outcomes were reviewed during a three-year period spanning the 18 months prior to Michigan's Medicaid expansion and the first 18 months following the expansion.

The study found outcomes did not significantly change in Virginia during the two 18-month periods. However, the risk-adjusted likelihood of a serious complication following heart surgery decreased by 30 percent in Michigan following its Medicaid expansion.

Post-expansion, Michigan Medicaid patients also had a lower predicted risk of mortality or major complications, possibly due to greater access to primary care.

"Once covered, these patients can now access necessary preventative services and primary care, hopefully leading to improved control of chronic medical conditions, such as diabetes and high blood pressure," Dr. Charles said. "This improvement in baseline health status prior to needing an operation may translate into lower preoperative predictive risk scores and subsequently lower postoperative rates of major complications."

Dr. Charles added better outcomes found in Michigan post-expansion could be influenced by younger and lower-risk patients who gained Medicaid eligibility under the ACA. Further research to explore outcomes for Medicaid patients prior to and after ACA expansion is needed, Dr. Charles said.   

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