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In 2014, many U.S. states began expanding their Medicaid programs under the Affordable Care Act (ACA) -- making more lower-income residents eligible for coverage. It's known that those expanded programs reduced the ranks of the uninsured in those states -- and, at least in some cases, improved access to health care.
The researchers found that by 2016, those death rates had continued to inch upward in states that had not expanded their Medicaid rolls. Deaths climbed in expansion states, too, but more slowly -- resulting in about 1,800 fewer deaths per year.
The findings do not prove that Medicaid expansion is the reason, said lead researcher Dr. Sameed Khatana, a fellow at the University of Pennsylvania, in Philadelphia.
"For example, those states may have been more enthusiastic in implementing other provisions of the ACA, too," he said.
Still, Khatana said, at a time when the value of Medicaid expansion is still being debated, the findings offer some concrete figures.
"Studies like this can be useful for states that are considering expansion of Medicaid eligibility," he said.
Khatana was scheduled to present the findings Friday at a meeting of the American Heart Association, in Arlington, Va. Studies presented at meetings are generally considered preliminary until they are published in a peer-reviewed journal.
As of February this year, 36 U.S. states and Washington, D.C. had opted to expand their Medicaid programs, according to the Kaiser Family Foundation. That left 14 states -- concentrated in the Southeast and Midwest -- as holdouts.
Some previous research has pointed to benefits from widening Medicaid eligibility -- including better insurance coverage for Americans younger than 65, who do not qualify for Medicare. Those newly insured people also seem to be taking advantage of it: A study published this week, for example, found that when West Virginia expanded its Medicaid program, more people started getting recommended treatments for opioid dependence.
By 2016, 29 states and Washington, D.C., had expanded Medicaid, while 19 had not.
Before 2014, the study found, there was no difference in cardiovascular death rates between expansion states and non-expansion states. But after expansion was implemented, the pattern changed.
The death rate continued to climb among both groups of states, but the increase was smaller in states that broadened Medicaid. That was true even after Khatana's team accounted for other factors -- such as poverty and unemployment rates, typical incomes and the availability of heart disease specialists on the county level.
Overall, expansion states had four fewer heart disease deaths per 100,000 residents per year, versus non-expansion states, the findings showed.
"Put a different way," Khatana said, "Medicaid expansion was associated with 1,800 fewer deaths per year in areas where it was implemented."
Laura Skopec is a researcher with the Health Policy Center at the Urban Institute, a Washington, D.C.-based nonprofit.
She said it's hard to know whether Medicaid expansion, per se, was responsible for the change in heart disease deaths.
"States that didn't expand Medicaid are different politically from the ones that did," Skopec said. "There may be other differences in the 'safety nets' of those states, too."
Still, she agreed that studies like this can help inform policymakers.
"We haven't known much about how Medicaid expansion is affecting people's actual health," Skopec said. "This study is a beginning, and more will be coming."
If the expansion did save lives in the short time frame of this study, it's not clear precisely how, Khatana said.
Past research, Khatana noted, has found that people without insurance may delay seeking care for a heart attack. So, he speculated, it's possible that's one way Medicaid expansion could make a fairly rapid dent in cardiovascular deaths.
Now a key question will be, what happens over the longer term? "We need to look farther on," Khatana said, "to see if these deaths rates keep separating further, or start narrowing."
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SOURCES: Sameed Khatana, M.D., fellow, cardiovascular disease, Hospital of the University of Pennsylvania, Philadelphia; Laura Skopec, M.S., senior research associate, Health Policy Center, Urban Institute, Washington, D.C.; April 5, 2019, presentation, American Heart Association scientific sessions, Arlington, Va.