AHA 2017: Affordable Care Act resulted in significant gains in health insurance for heart disease patients

November 13, 2017 – Medicaid plays an especially significant role for US adults with atherosclerotic cardiovascular disease (ASCVD).

Health insurance is one the strongest determinant of cardiovascular health, according to the DCRI’s Haider Warraich, MD.

“We talk a lot about the powerful effect of social determinants on health,” he said, “but we find that patients do best when they have access to good primary care and medications, which can mean increased screening for hyperlipidemia, diabetes, and other conditions, for example.”

Warraich presented results from his study at the annual American Heart Association meeting in Anaheim, California, this month.

“We wanted to figure out the gains in different kinds of health insurance on patients with heart disease,” said Warraich. “In this study, we looked at the insurance status of non-elderly patients with ASCVD before and after the passage and implementation of ACA.”

Warraich’s research is based on data from the Agency for Healthcare Research and Quality (AHRQ) Medical Expenditures Panel Survey, 2006-2015. Each year, samples were drawn from the previous year’s National Health Interview Survey – patient interviews were conducted every six months for 30 months and supplemented with additional information from physicians, pharmacies, and healthcare facilities.

Participants were non-institutionalized patients between the ages of 19-64 who had coronary heart disease, stroke, and peripheral arterial disease. Other risk factors included hypertension, diabetes mellitus, hypercholesterolemia, smoking, limited physical activity, and obesity.

Health insurance status ranged from private, including employer- and military-provided plans, to those who were uninsured for any part of an entire calendar year, and Medicaid. The study looked at trends before and after ACA was passed. The study showed that between 2010 and 2015, the percentage of ASCVD patients without insurance reduced from 19 percent to 13 percent. The total number of non-elderly Americans with ASCVD was 1.5 million in 2010 and 1.0 million in 2015.

“Our big finding,” Warraich said, “was that the ACA resulted in a substantial decrease in the number of uninsured non-elderly Americans with ASCVD, and that most of these patients gained their insurance through the expansion of Medicaid.” There were also “significant disparities” in insurance gains within the ASCVD population. As opposed to patients with middle income or those who were either poor or near poor, low income individuals showed no statistical reduction in the rates of uninsurance.