Public Release: 

Medicaid expansion linked with better, more timely surgical care

Harvard T.H. Chan School of Public Health

Boston, MA - The Affordable Care Act's Medicaid expansion was linked to better access to surgery and higher quality surgical care, according to a new study from Harvard T.H. Chan School of Public Health.

The study will be published online January 24, 2018 in JAMA Surgery.

"What was most striking was that we saw significant improvements in the treatment of surgical conditions fairly quickly, less than two years after states expanded Medicaid coverage," said lead author Andrew Loehrer, who conducted the study as a research fellow at Harvard Chan School.

Previous studies have examined the impact of the ACA's Medicaid expansion on a range of outcomes like primary care, prescription medication use, and self-reported health, generally finding favorable results. But this is the first study showing similar benefits for serious conditions requiring surgery.

The researchers looked at five years' worth of data from nearly 300,000 patients from 42 U.S. states who were admitted to hospitals for one of five common surgical conditions: appendicitis, cholecystitis, diverticulitis, peripheral artery disease (PAD), or aortic aneurysm. The study analyzed trends in insurance coverage, timeliness of surgical care, and care outcomes both before the ACA's Medicaid expansion (2010-13) and after (2014-15), comparing 27 states that chose to expand their Medicaid programs with 15 that chose not to expand.

The researchers found that Medicaid expansion was associated with:

  • A 7.5-percentage point decrease in the probability of patients being uninsured
  • An 8.6-percentage point increased probability of patients having Medicaid
  • A 1.8-percentage point increase in the probability of patients seeking care earlier, before their surgical conditions became complicated
  • A 2.6-percentage point increase in patients' probability of receiving optimal care

The researchers speculated that the ACA's Medicaid expansion led patients with surgical conditions to seek treatment before complications set in. Being treated for these conditions earlier makes it more likely that they will have better health outcomes, the authors said.

"The fate of the ACA and Medicaid remains a key policy debate," said senior author Benjamin Sommers, associate professor of health policy and economics at Harvard Chan School. "As policymakers continue to discuss major changes to the ACA, and the Trump administration advances reforms that could lead to fewer people covered by Medicaid, our findings provide important new evidence that Medicaid expansion is improving the quality of care for serious conditions affecting tens of thousands of Americans every year."

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"Association of the Affordable Care Act Medicaid Expansion With Changes in the Care of Surgical Conditions," Andrew P. Loehrer, David C. Chang, John W. Scott, Matthew M. Hutter, Virendra I. Patel, Jeffrey E. Lee, and Benjamin D. Sommers, JAMA Surgery, online January 24, 2018, doi: 10.1001/jamasurg.2017.5568

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Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people's lives--not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America's oldest professional training program in public health.

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