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Cardiovascular Disease-related Death Reduced after Medicaid Expansion

Fewer heart disease-related deaths occur in counties where Medicaid was expanded under the Affordable Care Act, according to a provocative new study.

Fewer heart disease-related deaths occur in counties where Medicaid was expanded under the Affordable Care Act (ACA), according to new research.

Based on findings presented at the American Heart Association’s Quality of Care Outcomes Research Scientific Sessions 2019, counties with more widely available Medicaid, as of 2016, experienced a small, but significantly lower cardiovascular mortality rate.

The largest benefit occurred in nonmetropolitan, high-poverty areas.

Heart disease and its risk factors are more prevalent among uninsured individuals. Consequently, Sameed Ahmed M. Khatana, MD, a cardiovascular disease fellow at the Hospital of the University of Pennsylvania, analyzed whether Medicaid expansion had a meaningful impact on middle-aged adults. This is one of the first large studies with that goal.

“We believe these findings will be helpful for policy makers and health policy researchers in trying to tease out the impact of this most recent round of expansion,” he said.

To determine the effect, researchers examined county-level, age-adjusted cardiovascular mortality rates collected from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research morality database. They included all individuals aged 45 to 64 years from 2010 to 2016. Adults from Massachusetts and Wisconsin were excluded, however, as Medicaid expansion in those states was non-ACA related.

Investigators included data from 1,960 counties in 29 states and Washington, DC. Based on results, expansion counties had greater health insurance coverage for low-income individuals than non-expansion counties [19.8% (SD=5.5) vs 13.5% (SD=3.9); p<.01].

While there were no significant differences observed in mortality rate trends before Medicaid expansion, the widened coverage produced a shift. Expansion counties experienced a significantly smaller cardiovascular mortality rate increase [141.9 (95% CI 135.6, 148.3) to 142.0 (95% CI 135.5, 148.6) deaths per 100 000 residents annually] than non-expansion counties [176.1 (95% CI 169.3, 182.8) to 180.6 (95% CI 173.2, 188.0) deaths per 100 000 residents annually].

After accounting for demographic differences and economic variables, researchers determined that, post-expansion, expansion counties had 4.0 (95% CI 2.1, 6.0) fewer cardiovascular-disease deaths per 100 000 residents annually than non-expansion counties.

Ultimately, Khatana said, results show Medicaid expansion could beneficially affect cardiovascular mortality.

“We can't necessarily say from our study that giving a person health insurance through Medicaid will save their life,” he said. “However, our study does show that there, perhaps, were at least widespread benefits concentrated in certain groups, such as those uninsured or people with higher risk of cardiovascular disease, although we can’t say for sure it was a direct result of the Medicaid expansion.”

Still, he added, states deliberating Medicaid expansion should consider the cardiovascular benefit in this population.


Khatana S, Bhatla A, Nathan A, et al. Association of Medicaid expansion with cardiovascular mortality-a quasi-experimental analysis. Circ Cardiovasc Qual Outcomes. (2019), doi: 10.1161/hcq.12.suppl_1.3