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Medicaid expansion increased low-income patient access to kidney transplants, research shows

Kidney transplantation is more cost-effective and associated with better health outcomes than dialysis, the authors said.

Jeff Lagasse, Associate Editor

After states expanded Medicaid to cover more low-income individuals under the Affordable Care Act, there was a significant boost in the number of chronic kidney disease patients with Medicaid coverage who were placed on the kidney transplant waiting list, according to a new study led by Drexel University researchers.

Medicaid expansion was associated with larger increases in Medicaid coverage among new listings of racial and ethnic minority patients compared to listings of white patients -- suggesting that expansion may have helped to curb racial and socioeconomic disparities in pre-dialysis chronic kidney disease care.

More than 93,000 people are currently listed for a new kidney, according to the U.S. Department of Health and Human Services. While black and Hispanic Americans have higher rates of diabetes and high blood pressure than white Americans, putting them at risk for organ failure, patients who were white or had private health insurance were historically more likely to receive an organ transplant.

Kidney transplantation is more cost-effective and associated with better health outcomes than dialysis, the authors said. Getting on the waiting list early can shorten the amount of time kidney transplant candidates need to endure dialysis before getting a transplant, with average waiting times of five to seven years. But access to the list is largely dependent on having health insurance coverage, and Medicare only provides a health insurance "safety net" for those without other insurance coverage after they start dialysis.

The researchers found that states that expanded their Medicaid programs experienced an increase in preemptive listings of Medicaid beneficiaries. States that fully implemented Medicaid expansion on January 1, 2014 had a 59 percent relative increase in Medicaid-covered preemptive listings -- 1,094 to 1,737 patients -- from the pre-expansion period (years 2011-2013) to the post-expansion period (years 2014-2016), compared with an 8.8 percent relative increase among Medicaid non-expansion states. From the pre- to post-expansion period, the adjusted proportion of listings with Medicaid coverage increased by 3 percent among expansion states and decreased by 0.3 percentage-points among non-expansion states.

The authors also found that in expansion states, the proportion of new black listings with Medicaid coverage increased by 4 percentage points, and the proportion of new Hispanic listings with Medicaid coverage increased by 5.9 percentage points, whereas the proportion of new white listings with Medicaid coverage increased by only 1.4 percen.

With respect to cost, the study authors note that spending for chronic dialysis in the U.S. currently exceeds $30 billion per year.

In addition to those benefits, Medicaid expansion has been shown to boost the survivability of state hospitals; help shore up local economies that would have suffered under hospital closures; and help improve patient volume for physicians.

Twitter: @JELagasse
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