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- Title
Association Between the ACA Medicaid Expansions and Changes in Cardiovascular Risk Factors Among Low-Income Individuals.
- Authors
Gotanda, Hiroshi; Kominski, Gerald F.; Elashoff, David; Tsugawa, Yusuke
- Abstract
Background: Evidence is limited as to whether the introduction of the Affordable Care Act (ACA)'s Medicaid expansions was associated with improvements in cardiovascular risk factors at the population level. Objective: To examine the association between the ACA Medicaid expansions and changes in cardiovascular risk factors among low-income individuals during the first 3 years of the implementation of the ACA Medicaid expansions at the national level. Design: A quasi-experimental difference-in-differences (DID) analysis to compare outcomes before (2005–2012) and after (2015–2016) the implementation of the ACA Medicaid expansions between individuals in states that expanded Medicaid and individuals in non-expansion states. Participants: A nationally representative sample of individuals aged 19–64 years with family incomes below 138% of the federal poverty level from the 2005–2016 National Health and Nutrition Examination Survey (NHANES). Intervention: ACA Medicaid expansions. Main Measures: Cardiovascular risk factors included (1) systolic and diastolic blood pressure, (2) hemoglobin A1c (HbA1c) level, and (3) cholesterol levels (low-density lipoprotein cholesterol, triglyceride, and high-density lipoprotein cholesterol). Key Results: A total of 9177 low-income individuals were included in our analysis. We found that the ACA Medicaid expansions were associated with a lower systolic blood pressure (DID estimate, − 3.03 mmHg; 95% CI, − 5.33 mmHg to − 0.73 mmHg; P = 0.01; P = 0.03 after adjustment for multiple comparisons) and lower HbA1c level (DID estimate, − 0.14 percentage points [pp]; 95% CI, − 0.24 pp to − 0.03 pp; P = 0.01; P = 0.03 after adjustment for multiple comparisons). We found no evidence that diastolic blood pressure and cholesterol levels changed following the ACA Medicaid expansions. Conclusion: Using the nationally representative data of individuals who were affected by the ACA, we found that the ACA Medicaid expansions were associated with a modest improvement in cardiovascular risk factors related to hypertension and diabetes during the first 3 years of implementation.
- Subjects
CARDIOVASCULAR diseases risk factors; HDL cholesterol; LDL cholesterol; HEALTH &; Nutrition Examination Survey; MEDICAID
- Publication
JGIM: Journal of General Internal Medicine, 2021, Vol 36, Issue 7, p2004
- ISSN
0884-8734
- Publication type
Article
- DOI
10.1007/s11606-020-06417-6