Expansion of Insurance Under the Affordable Care Act and Invasive Management of Acute Myocardial Infarction

Julian S Haimovich; Jinghan Cui; Robert W Yeh; Timothy G Ferris; John Hsu; Jason H Wasfy

doi:10.1016/j.carrev.2021.10.003

Expansion of Insurance Under the Affordable Care Act and Invasive Management of Acute Myocardial Infarction

Cardiovasc Revasc Med. 2022 Jun:39:90-96. doi: 10.1016/j.carrev.2021.10.003. Epub 2021 Oct 9.

Authors

Julian S Haimovich¹, Jinghan Cui², Robert W Yeh³, Timothy G Ferris⁴, John Hsu⁵, Jason H Wasfy⁶

Affiliations

¹ Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
² Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
³ Department of Medicine, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁴ Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Massachusetts General Physicians Organization, Boston, MA, USA.
⁵ Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
⁶ Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Massachusetts General Physicians Organization, Boston, MA, USA. Electronic address: jwasfy@mgh.harvard.edu.

PMID: 34756520
DOI: 10.1016/j.carrev.2021.10.003

Abstract

Background: The Affordable Care Act of 2010 extended health insurance through expansion of Medicaid and subsidies for commercial insurance. Prior work has produced differing results in associating expanded insurance with improvements in health care processes and outcomes. Evaluating specific mechanisms of care processes and their association with insurance expansion may help reconcile those results.

Methods and results: We used inpatient hospitalization data in the Nationwide Inpatient Sample (NIS) Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality from 1/1/2008 to 9/30/2015. We included all hospitalizations for acute myocardial infarction (AMI). As a primary outcome, we defined percent rate of AMI hospitalizations receiving percutaneous coronary intervention (PCI) per month. In the non-Medicare (intervention) group, there was a relative decrease of 0.2% of the monthly trend before and after expansion (95% CI [-0.3%, -0.1%]). In the Medicare group, there was a relative decrease of 0.1% of the monthly trend before and after expansion (95% CI [-0.2%, 0%]).

Conclusions: We did not detect a relative difference in PCI for AMI associated with insurance expansion under health reform.

Keywords: Cardiovascular disease; Insurance; Outcomes.

MeSH terms

Aged
Health Care Reform
Humans
Insurance Coverage
Insurance, Health
Medicaid
Medicare
Myocardial Infarction* / diagnosis
Myocardial Infarction* / therapy
Patient Protection and Affordable Care Act
Percutaneous Coronary Intervention* / adverse effects
United States / epidemiology