The 2014 Medicaid Expansion, Access to Care, and Heart Attack Mortality

Abstract

In March 2010, the Affordable Care Act was passed by Congress, including a provision that expanded access to Medicaid to all individuals with an income of 138% of the federal poverty level or less. In National Federation of Independent Business v. Sebelius, the Supreme Court struck down the provision that required states to expand Medicaid or lose pre-existing funding, allowing each state to voluntarily make the decision whether to expand Medicaid or not. Medicaid expansion was implemented beginning in January 2014, and as of now 37 states have expanded Medicaid. Medicaid expansion is associated with increased access to care, including decreases in uninsurance, greater utilization of health care services, and better performance on measures of quality to care. The body of research indicated that heart attacks are sensitive to access to care. Delays in seeking care in the event of a heart attack have a significant impact in how much heart muscle can be saved, and people with less access to care may find it more difficult to receive timely care. This study used data from the Health Care Utilization Project to investigate the impact of Medicaid expansion on the proportion of fatal heart attacks. Ultimately, data analysis found that from 2013 to 2016, the proportion of fatal heart attacks decreased significantly in expansion states but did not decrease in non-expansion states, suggesting that Medicaid expansion reduced the proportion of fatal heart attacks.