Health Policy$ense

Lower Cardiovascular Mortality Linked to Medicaid Expansion

Award winner at American Heart Association Conference

Add this to the expanding list of the benefits of the ACA’s Medicaid expansion. In JAMA Cardiology, a new study by LDI Associate Fellow Sameed Khatana and colleagues finds that Medicaid expansion was associated with lower cardiovascular mortality in adults aged 45-64.

As of 2016, 29 states and Washington, DC had expanded Medicaid eligibility, while 19 states had not (excluding Massachusetts and Wisconsin, due to non-ACA related Medicaid expansion). Not surprisingly, expansion states had a greater decrease in uninsured rates than non-expansion states. After accounting for demographic, clinical, and economic differences, counties in expansion states had 4.3 fewer deaths per 100,000 residents per year from cardiovascular causes after Medicaid expansion than if they had followed the trajectory of non-expansion states. As shown below, the mortality differences between the two increased in 2014 and 2015 and narrowed again in 2016.


Sameed Ahmed Khatana, MD, MPH, winner of AHA’s Early Career Investigator Award. He is a Fellow in Cardiovascular Disease, Perelman School of Medicine, and an LDI Associate Fellow.

The counties in these expansion states had a population of 47.4 million middle-aged adults in 2014. The findings translate to a total of 2,039 fewer deaths per year in 45-64 year old residents from cardiovascular causes after Medicaid expansion.

The study does not identify the direct and indirect mechanisms by which Medicaid expansion could achieve these results; the authors speculate that it could be directly through improvements in timely access to outpatient and emergency care, or indirectly through bolstering the financial health of institutions that provide care to poorer populations.

The abstract for the paper was presented at the American Heart Association Quality of Care and Outcomes Research conference in April and Khatana won the Early Career Investigator Award for it.

The study, "Association of Medicaid Expansion With Cardiovascular Mortality," was published online in JAMA Cardiology on June 5, 2019. Authors include LDI fellows Sameed Khatana, Ashwin Nathan, Jay Giri, and Peter Groeneveld, from Penn Medicine’s Cardiovascular Outcomes, Quality, and Evaluative Research (CAVOQER) Center.