Medicaid expansion linked to reduced mortality among dialysis patients

In the first three years of Medicaid expansion due to the Affordable Care Act, the number of patients with end-stage kidney disease who died within a year of starting dialysis decreased in states that expanded Medicaid compared to non-expansion states, new research has found.

The study, led by Brown University researchers, was published in the Journal of the American Medical Association.

IMPACT

The adjusted absolute reduction in mortality in expansion states versus non-expansion states was 0.6 percentage points. Since end-stage renal disease affects more than 100,000 Americans each year, 0.6 percentage points equals hundreds of deaths annually.

Healthcare is still a top issue for voters heading into next week's midterm elections, and polls show Democrats largely have the support of voters on the topic, due in part to GOP efforts to repeal and replace the Affordable Care Act, efforts that thus far have been unsuccessful.

WHAT ELSE YOU SHOULD KNOW

In Medicaid expansion states, the number of patients who died within the first year of beginning dialysis -- defined in the study as from the 91st day to the end of the 15th month of dialysis treatment -- decreased from 6.9 percent prior to expansion to 6.1 percent after expansion, a total reduction of 0.8 percentage points.

In non-expansion states, the mortality rate was 7 percent from January 2011 to January 2014 (prior to the ACA) and 6.8 percent from January 2014 to March 2017, a reduction of 0.2 percentage points.

Medicaid expansion also improved pre-dialysis care for kidney disease, as indicated by the surgical placement of a fistula or graft before beginning dialysis. Fistulas and grafts -- two methods for accessing the bloodstream for dialysis -- are less likely to become infected than temporary venous catheters, and in expansion states there was an increase of 2.3 percentage points in the number of patients beginning dialysis with a fistula or graft.

The study also found that black patients and patients between the ages of 19 and 44 had larger decreases in mortality rates, by 1.4 percentage points and 1.1 percentage points respectively. That's likely because those groups traditionally had lower rates of insurance.

THE TREND

In January 2014, 25 states and the District of Columbia extended Medicaid to non-elderly residents with incomes at or below 138 percent of the poverty level, while 25 states did not -- though eight more have expanded Medicaid since then.

Much research has been conducted examining the effects of Medicaid expansion. Earlier this year it was revealed that people with disabilities are much more likely to be employed in states that have expanded Medicaid coverage.

THEIR TAKE

While the authors caution that more research is needed to determine exactly what caused the decrease in deaths, the study suggests expanded insurance coverage, which provides better access to care, is a key factor in reducing mortality. Medicaid expansion reduced the rate of end-stage renal disease patients without insurance, by 4.2 percentage points.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com