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Fewer people died from heart disease in states that expanded Medicaid coverage through the Affordable Care Act

Counties in states that expanded Medicaid had about four fewer deaths from heart disease per 100,000 residents compared to other states.

Jeff Lagasse, Associate Editor

Counties in states that expanded Medicaid coverage under the Affordable Care Act had fewer deaths annually from heart disease compared to areas that did not expand Medicaid, according to preliminary research presented at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions 2019.

Medicaid expansion under the ACA, which occurred in 2014, led to one of the largest gains in health insurance coverage for non-elderly adults in the U.S.

Because cardiovascular disease and risk factors have a higher prevalence in uninsured people, researchers wanted to determine if Medicaid expansion had any meaningful effect in that population by studying whether trends in cardiovascular mortality for middle-aged adults differed between states that did and did not expand Medicaid.

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There appears to be a link between Medicaid expansion and lower mortality rates.

There was an increase in health insurance coverage for low-income residents in counties in expansion states (19.8 percent) compared with counties in non-expansion states (13.5 percent).

Counties in states that expanded Medicaid had about four fewer deaths from heart disease per 100,000 residents compared to states that didn't expand Medicaid, which translates to about 1,800 fewer deaths per year in expansion areas.

Counties with more residents living in poverty seemed to benefit most from the effect of the expansion. The researchers also found counties that had the smallest increases in insurance coverage from 2010 to 2016 had the largest increases in cardiovascular death rates.


The researchers used data from the Centers for Disease Control and Prevention's Online Data for Epidemiologic Research mortality database to grab county-level cardiovascular mortality rates for everyone 45 to 64 years old from 2010 to 2016. They used data from all states except Massachusetts and Wisconsin, which expanded Medicaid independently of the ACA.

As of 2016, 29 states and the District of Columbia had expanded Medicaid eligibility, while 19 states had not. A total of 1,960 counties were included.


Hospitals, physicians and insurer groups are united in wanting to preserve the ACA and have defended it in briefs filed with the Fifth Circuit Court of Appeals.

The American Hospital Association, the American Medical Association and America's Health Insurance Plans are among groups that are fighting a lower court ruling in Texas that struck down the law.

Opposing them is the Department of Justice, which in March reversed an earlier opinion and sided with the Texas judge who ruled that without the individual mandate, the entire ACA has no constitutional standing.

Twitter: @JELagasse

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