LDN - Health and Fitness

Obamacare tied to fewer uninsured hospitalizations for heart disease, cancer

[August 30, 2018] By Lisa Rapaport

(Reuters Health) - With increased access to insurance under the Affordable Care Act (ACA), known as Obamacare, fewer uninsured patients have been hospitalized for serious heart conditions, a U.S. study suggests.

For the study, researchers examined data on more than 3 million hospitalizations for heart attacks, strokes and heart failure in 30 states between 2009 and 2014. During the final year of the study, 17 states took advantage of provisions in the ACA to help fund expanded enrollment in Medicaid, the health program for the poor.

States that expanded Medicaid in 2014 saw the uninsured proportion of hospitalizations for serious heart problems decrease by 5.4 percentage points, from 13.1 percent before the ACA took effect to 7.7 percent afterward, researchers report in JAMA Network Open. They also saw the proportion of these hospitalizations covered by Medicaid increase by 9.5 percentage points, from 25.6 percent to 35.1 percent.

In states that didn't expand Medicaid, however, the uninsured proportion of hospitalizations for major heart issues dipped just 0.7 percentage points in 2014 and the proportion of these hospitalizations covered by Medicaid inched up just 0.4 percentage points.

"Being hospitalized for a major cardiovascular condition such as a heart attack, stroke or heart failure can be devastating not only health-wise but also financially," said study author Dr. Ehimare Akhabue of Rutgers University Robert Wood Johnson School of Medicine in Piscataway Township, New Jersey.

"Cardiovascular disease is also one of the leading sources of medical spending in the United States," Akhabue, who completed the research at Northwestern University in Chicago, said by email. "Thus, low income individuals who were previously uninsured and received access to Medicaid may have benefited with lower out-of-pocket costs for such hospitalizations."

Previous research suggests that Medicaid expansion may also improve access to outpatient care, Akhabue added.

"More study is needed to see if this improved access helped to prevent hospitalizations for major cardiovascular conditions," Akhabue said. "Hopefully, better access to care would not only help prevent cardiovascular hospitalizations in the future but when they do occur, people would have adequate access to insurance."

One thing the study didn't find is a difference in survival. Death rates in hospitals for heart attack, stroke, and heart failure held constant before and after the ACA and didn't appear to be influenced by whether states opted to expand Medicaid.

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"In the longer run, having insurance might prevent heart attacks and strokes, but that type of prevention takes time," Dr. Karen Joynt Maddox, co-author of an accompanying editorial and a researcher at Washington University School of Medicine in St. Louis, said by email.

A separate study appearing in JAMA Oncology examined diagnosis of early-stage cancer before and after the ACA. This analysis too suggests it will take more time to see how well Obamacare works at getting more people preventive checkups and screenings.

This study looked at data collected from 2010 to 2014 on almost 2.5 million cancer patients in states that expanded Medicaid after the ACA and another 1.2 million cancer patients in non-expansion states.

The proportion of uninsured cancer patients declined across all of the states in 2014, the study found. Decreases were greater in states that expanded Medicaid and were greatest in expansion states with the highest proportion of uninsured people before the ACA took effect.

When researchers looked at all cancers combined, Medicaid expansion was associated with a slight shift toward more diagnoses of early-stage cancer instead of advanced tumors that are harder to treat.

But for specific cancers, there were no statistically meaningful changes in how advanced tumors were at the time of diagnosis.

"It may be too early to observe such changes because we only had data through 2014, one year after most states expanded Medicaid," said lead study author Xuesong Han of the American Cancer Society in Atlanta.

Researchers should continue monitoring cancer stage at diagnosis with more years of data after the ACA, Han said by email, along with changes "in receipt of evidence-based cancer treatment and survival after a cancer diagnosis for patients living in Medicaid expansion states compared with non-expansion states."

SOURCE: https://bit.ly/2C0czaM and https://bit.ly/2orGpvv JAMA Network Open, online August 24, 2018; https://bit.ly/2PjAnZf JAMA Oncology, online August 23, 2018.

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