A. S. Chiu1, R. A. Jean1, J. Ross2, K. Y. Pei1 1Yale University School Of Medicine,Surgery,New Haven, CT, USA 2Yale University School Of Medicine,Internal Medicine,New Haven, CT, USA
Introduction:
In 2014, the expansion of Medicaid under the Affordable Care Act allowed states to extend Medicaid benefits to adults with incomes less than 138% of the federal poverty level. Although the Supreme Court ruled that states could opt out of Medicaid expansion, 26 states and the District of Columbia expanded Medicaid eligibility in 2014, with five more states subsequently doing the same. Medicaid expansion has contributed to a decrease in the number of uninsured patients and an increase in the utilization of primary care services; however, it remains unclear whether this has translated into increased insurance coverage for surgical patients.
Methods:
The National Inpatient Sample (NIS) is the largest all-payer, nationally representative database in the United States. Discharges for the 10 most burdensome emergency general surgery operations (defined as a combination of frequency, cost, and morbidity), were identified in the NIS between 2010-2014. Weighted averages were used to produce nationally-representative estimates. The primary outcome studied was the distribution of insurance type for surgical patients before and after Medicaid expansion in 2014.
Results:
After Medicaid expansion, the proportion of operative admissions covered under Medicaid rose from 15.5% to 18.5% (p<.001), or by approximately 20%. Over the same time, the proportion of uninsured surgical patients decreased from 8.9% to 6.6% (p<.001). In total this translated into an increase of 32,185 general surgery patients who were covered under Medicaid, and 34,305 fewer uninsured general surgery patients. The percentage of privately insured patients decreased from 40.9% in 2010 to 36.2% in 2014 (p<.001), while the percent of Medicare patients rose from 30.4% to 35.4% (p<.001) over the same period.
Conclusion:
In the first year of Medicaid expansion alone, data from a nationally representative sample shows that the number of general surgery patients covered by Medicaid increased by more than 30,000, while the number of uninsured general surgery patients fell by nearly 35,000. The proportion of private insurance has also gone down over this period, with a reciprocal rise in Medicare coverage, likely explained by demographic shifts towards an aging population. Continued study is needed to evaluate the ongoing impact Medicaid expansion is having on coverage for surgical patients.
