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By Lisa Rapaport
(Reuters Health) – According to a US study, a growing number of older people dying from heart disease die from heart disease thanks to increased access to insurance offered by Obabacare, Affordable Care Act (AbA).
As part of the ACA, some US states have expanded coverage through Medicaid – a federal and state insurance program geared to the poor – starting in 2014. This study compared death rate from cardiovascular disease among people aged 45 to 64 from 2010 to 2016 in 29 states. who has expanded Medicaid and 19 states that do not have it.
Annual death rates from cardiovascular causes have remained constant – about 146 deaths per 100,000 people – in states that have extended Medicaid coverage, the study revealed.
But in states that did not allow more people to get Medicaid coverage, cardiovascular death rates increased during the study, from about 176 to 181 deaths per 100,000 population.
"Our study is one of the first to show that Medicaid's expansion is badociated with lower mortality rates due to cardiovascular causes," said Dr. Sameed Khatana, lead author of the study. study, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
"Given the intense debate around the Affordable Care Act and the expansion of Medicaid, it is important that patients, service providers and policymakers know that Medicaid's expansion has been badociated with real changes in the number of people dying from heart disease, "said Khatana. by email.
The study was not a controlled experiment designed to prove whether, or how, extensive coverage of Medicaid could have a direct impact on heart disease death rates. And it is possible that other policies or factors specific to certain states have had an impact on the results.
But extending coverage to many people who were not previously insured probably played a role, Khatana said.
"This could lead to better access to preventive care and protective heart medications such as aspirin and cholesterol-based drugs," Khatana added. "In addition, previous studies have shown that lack of insurance leads people to delay care even in the event of a heart attack."
For this study, researchers examined county-level data on age-adjusted cardiovascular mortality rates in 48 states and in Washington, DC – with the exception of Mbadachusetts and Ontario. Wisconsin.
In states that have extended Medicaid, the percentage of uninsured residents, all incomes combined, decreased by 7.3% on average, and the percentage of poor people without insurance, by nearly 20%, researchers reported in JAMA. Cardiology.
By comparison, in the States that did not extend Medicaid, the percentage of uninsured residents, all income combined, decreased by only 5.6% and the proportion of uninsured poor only decreased by 13%, 5%.
One of the limitations of the study is that states that expanded their Medicaid activities had lower cardiovascular mortality rates than other states even before expanding.
"As a result, it becomes difficult to take into account how other factors, apart from the expansion of Medicaid, have contributed to the decline of these states," said Dr. Khurram Nasir, a researcher at Yale University of New Haven, Connecticut, who did not participate in the project. study.
"Unfortunately, states that refused to expand Medicaid were probably the ones who needed it most," Nasir said via email.
There could also be a limit to reducing mortality rates by expanding Medicaid coverage, said Dr. David Himmelstein of Albert Einstein College of Medicine and Montefiore Medical Center in New York.
"Medicaid is not really adequate coverage because it pays so low fees in most states that patients often have trouble finding a doctor willing to treat them," Himmelstein said, not involved in the study, by e-mail.
"In addition, many people with coverage still can not afford care because of the high deductibles and co-payments," added Himmelstein. "Although Medicaid generally badumes little or no co-payments or deductibles, even very low personal expenses discourage care, especially among the poor."
SOURCE: http://bit.ly/31gbkNj JAMA Cardiology, online June 5, 2019.
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