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ACA expansion did not improve access to complex surgeries for low-income, minority patients

That result surprised researchers, since the ACA's Medicaid expansion has increased access to surgical care overall.

Jeff Lagasse, Associate Editor

A look at the Affordable Care Act's Medicaid expansion finds that despite expectations, there was no increased use of complex surgical procedures at high volume hospitals -- a proxy for high-quality hospitals -- among ethnic/racial minorities and low-income populations.

The findings came from comparing surgery records from high-volume hospitals in three states that opted into the ACA's Medicaid expansion with similar hospitals in two states that did not expand their Medicaid program.

The study, published in Journal of the American College of Surgeons, suggests that, in its infancy, Medicaid expansion under the ACA does not appear to reduce disparities in use of regionalized surgical care among vulnerable people.

The researchers found that while more patients overall had access to complex surgeries in the expansion states than before ACA was enacted, the proportions of low-income individuals and racial/ethnic minorities receiving their complex surgery at high volume hospitals did not increase.

Authors have suggested that a number of issues may be at play, including patient, referring physician and hospital factors.

For example, patients may prefer to have their surgery at low-volume hospitals -- closer to where they live -- or are unable to travel to high volume hospitals; physician referral patterns may not have changed in this short timeframe; and/or some hospitals may limit the number of Medicaid patients they treat given their high number of privately insured patients.

Researchers said they hope the findings will spur further investigations into what may be contributing to continued disparities in utilization of regionalized surgical care at high-volume hospitals.

The results surprised researchers, since the ACA's Medicaid expansion has increased access to surgical care overall. This suggests a possible limitation of the program to those with complex surgical problems.

It's been a good news/bad news situation for the ACA of late, as earlier this week it was reported that the law may have improved access to insurance and usual sources of care for Latinos of Mexican heritage. 

The ACA was signed into law in March 2010, and insurance exchanges utilizing the expansion of Medicaid took effect January 1, 2014.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com

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