Trends in Durable Ventricular Assist Device Implantation Rates with the Affordable Care Act and Medicaid Expansion

Pilot Project

Trends in Durable Ventricular Assist Device Implantation Rates with the Affordable Care Act and Medicaid Expansion

Abstract: The Affordable Care Act (ACA) lead to one of the largest expansion of health insurance coverage in non-elderly adults, particularly in those eligible for Medicaid. There is evidence that the ACA has led to increases in healthcare utilization and access. However, the impact on health outcomes for patients is still unclear. There are only two treatment options for patients with end-stage heart failure that can prolong life and improve quality of life long term, heart transplantation and ventricular assist device (VAD) implantation. Both of these treatment options are generally not available to uninsured individuals. Additionally, congestive heart failure is more prevalent in African Americans and in people of lower socioeconomic status, both populations with lower rates of health insurance coverage prior to the ACA. Therefore, expansion of health insurance coverage may have had a more significant impact among patients with end-stage heart failure. In order to assess this, we plan to examine age, sex and race stratified rates of VAD implantation for non-elderly adults using the Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) and compare with patients above 65 years of age before and after implementation of the ACA. We will also compare rates of VAD implantation between states that expanded Medicaid eligibility and those that did not. By studying this high-risk group, we hope to identify possible changes in health outcomes related to recent health reform efforts.