D. Tatum1, S. Taghavi1,2, A. Smith2, S. Baker2, R. Schroll2, C. Guidry2, P. McGrew2, C. McGinness2, T. Jacome1, J. Duchesne2 1Our Lady of the Lake Regional Medical Center,Trauma Specialist Program,Baton Rouge, LA, USA 2Tulane University School Of Medicine,Department Of Surgery,New Orleans, LA, USA
Introduction:
As part of the Affordable Care Act (ACA), Medicaid in Louisiana was expanded to include non-disabled, low income, non-elderly adults, providing a unique opportunity to examine the effect of insurance status on trauma patients in a historically low socioeconomic status (SES) region. How Medicaid expansion has influenced outcomes in an urban population with a high volume of uninsured patients has yet to be examined on the local level in Louisiana. We hypothesized that there would be a significant decrease in uninsured patients without a concomitant decrease in mortality.
Methods:
All patients aged 18 – 64 were identified in the trauma registries at two major regional trauma centers. Medicaid expansion in Louisiana began July 1, 2016. As such, the pre-expansion study period was July 1, 2015 – June 30, 2016. The post-expansion period was July 1, 2016 – June 30, 2017. Chi Square and Mann-Whitney U test were used for statistical analysis. Significance was set at P < 0.05.
Results:
A total of 8,088 patients met study criteria. Of these, 3,607 (45%) were pre-expansion, 4,481 (55%) were post-expansion. After expansion, Medicaid rates doubled from 22% to 44% (P< 0.001), and the uninsured rate decreased from 40% to 21% (P<0.001). Though number of patients increased post-expansion, median (IQR) ISS decreased significantly (see table). There was no difference in race (P = 0.782), injury type (66% blunt pre-expansion vs 66% blunt post expansion; P =0.757), or overall mortality (4.7% pre vs 3.7% post; P = 0.194); however, patients in the post-expansion cohort had shorter hospital and ICU length of stay.
Conclusion:
While Medicaid expansion in Louisiana has not reduced mortality in nonelderly trauma patients, it may have resulted in better in-hospital outcomes. In addition, expansion may explain increased patient volume and decreased ISS, as formerly uninsured patients with mild injuries may have refused care in the past. Future studies are needed to further delineate the impact of Medicaid expansion in the trauma population.
