Medicaid expansion has helped more young, low-income adults with advanced kidney disease to avoid the costs and poor quality of life associated with dialysis, finds a study in the Journal of General Internal Medicine, compiled by researchers at Drexel University College of Medicine and the Dornsife School of Public Health at Drexel.
The study included 15,775 U.S. adults ages 21-64 who received a preemptive kidney transplant -- basically, a transplant before needing dialysis treatment -- from 2010-2017.
The team examined the numbers of living and deceased donor kidney transplants, respectively, that occurred during the four years leading up to Medicaid expansion, and the four years following the date of expansion in states that opted to expand it as part of the Affordable Care Act. They then compared that data to trends in preemptive transplants in states that chose not to expand Medicaid.
WHAT'S THE IMPACT
The overall number of preemptive kidney transplants covered by Medicaid have increased by 37 percent in states that did not expand Medicaid and by 66 percent in states that did expand Medicaid, researchers found. Medicaid-covered preemptive, living-donor kidney transplants increased by 0.7% in non-expansion states, and by 2.2% in expansion states.
About 37 million Americans suffer from chronic kidney disease, a condition in which the kidneys cannot properly pass waste and filter blood. In the advanced form of chronic kidney disease, a living donor transplant is often the best option to avoid dialysis, but health insurance is needed to cover the costs of the procedure.
Although transplant before the need for dialysis treatment is the ideal scenario for patients with advanced kidney disease, Medicare coverage is only available to non-elderly patients after they begin dialysis. The shortage of kidneys available for transplant requires that people without a living donor often wait for five to 10 years on dialysis before receiving a transplant, and many die on dialysis before they get that opportunity.
Last year, there were 36,500 transplants of any organ in the U.S. A total of 21,167 of these, 59 percent, were kidney transplants, according to the United Network for Organ Sharing.
THE LARGER TREND
The findings come after President Donald Trump's signing of an executive order in July aimed at improving kidney care. Its goals include increasing rates of preemptive kidney transplant, identifying and treating at-risk populations in the earlier stages of kidney disease, and removing financial barriers to living organ donations.
The study also comes at a time when the fate of the ACA, and Medicaid expansion, are in question.
A total of 33 states and Washington D.C. have expanded Medicaid under the Affordable Care Act, covering millions of previously uninsured Americans -- including those with kidney disease who are not dialysis-dependent.
Still, 30 percent of the lowest-income individuals in the U.S. with kidney disease were uninsured in 2015 and 2016, despite coverage gains made by Medicaid.