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Session: : Highlighted Original Research

The Impact of the Affordable Care Act Medicaid Expansion in Patients with Peripheral Artery Disease

Saturday, September 9, 2023
8:40 AM – 9:00 AM EDT
Location: Constitution CDE

    Speaker(s)

  • SH

    Stanislav Henkin, MD, MPH, RPVI

    Senior Associate Consultant
    Mayo Clinic
    Rochester, Minnesota, United States

    • Discussant(s)

  • PG

    Philip Goodney, MD, MS

    Professor of Surgery, Heart and Vascular Center
    Dartmouth-Hitchcock Medical Center, United States

    • Co-Author(s)

  • SK

    Stephen Kearing, MS

    Healthcare Data Analyst
    Dartmouth Institute for Health Policy and Clinical Practice, United States

  • NZ

    Nikolaos Zacharias, MD, MPH

    Vascular Surgery
    Massachusetts General Hospital, United States

  • Mark Creager, MD

    Physician, Heart and Vascular Center
    Dartmouth-Hitchcock Medical Center
    Lebanon, New Hampshire, United States

  • PG

    Philip Goodney, MD, MS

    Professor of Surgery, Heart and Vascular Center
    Dartmouth-Hitchcock Medical Center, United States

  • MY

    Michael Young, MD

    Assistant Professor of Medicine, Heart and Vascular Center
    Dartmouth-Hitchcock Medical Center, United States

  • JC

    Jesse Columbo, MD

    Assistant Professor of Surgery, Heart and Vascular Center
    Dartmouth-Hitchcock Medical Center, United States

Description of Background: In 2014, the Affordable Care Act Medicaid expansion (ME) increased Medicaid eligibility for adults with an income level up to 138% of federal poverty threshold, leading to an overall decline in the uninsured population by 47% in 2016. The impact of ME on the outcomes in patients with peripheral artery disease (PAD) is unknown. In this study, we examined the impact of ME on mortality and amputation in patients with PAD.

Methods: The 100% MedPAR and Part-B Carrier files from 2011-2018 were queried to identify all fee-for-service Medicare beneficiaries with PAD using ICD codes. Our primary exposure was whether a state had adopted the ME on January 1, 2014. Our primary outcomes were all cause 1-year mortality and major leg amputation. We used a state-level difference-in-differences (DID) analysis to compare the rates of the primary outcomes among patients who were in states who adopted ME (n=25) versus those who were in states that did not (n=26). We performed a pre-specified sub-analysis of patients who were Medicare/Medicaid dual eligible.

Results: Over the 8-year period, we studied 37,743,929 patients, with a mean age of 78.4±8.30 years; 54.4% were female, 8.2% were black, and 22.0% were Medicare/Medicaid dual eligible. The unadjusted 1-year mortality improved in both non-ME (9.76% to 9.32%, p< 0.001) and ME (9.21% to 8.77%, p< 0.001) states. Across the entire cohort, the DID model revealed that ME did not lead to a significant change in mortality (p=0.87). Among dual eligible patients, the unadjusted rate of death increased in non-ME states (15.27% to 15.70%, p< 0.001) but not in expansion states (14.23% to 14.22%, p=0.94). Among dual-eligible patients, the DID model demonstrated that ME was associated with lower mortality in ME states (p=0.01). There was no association between ME and rates of amputation in the overall cohort or among dual-eligible patients with PAD.

Conclusion: Implementation of ME was associated with a decrease in mortality among dual-eligible patients with PAD. Policymakers in states without ME should consider the implication of these findings when making decision about expanding dual eligibility.

Learning Objective: To describe the impact of Medicaid Expansion on outcomes in patients with peripheral artery disease.