Author + information
- Received August 18, 2016
- Revision received October 26, 2016
- Accepted October 26, 2016
- Published online January 30, 2017.
- Khadijah Breathett, MDa,∗ (, )
- Larry A. Allen, MD, MHSa,
- Laura Helmkamp, MSb,
- Kathryn Colborn, PhDb,
- Stacie L. Daugherty, MD, MSPHa,
- Prateeti Khazanie, MD, MPHa,
- Richard Lindrooth, PhDc and
- Pamela N. Peterson, MD, MSPHa,d
- aUniversity of Colorado, Anschutz Medical Campus, Division of Cardiology, Aurora, Colorado
- bUniversity of Colorado Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, Colorado
- cUniversity of Colorado, Department of Health Systems, Management and Policy in the Colorado School of Public Health, Aurora, Colorado
- dDenver Health Medical Center, Denver, Colorado
- ↵∗Reprint requests and correspondence:
Dr. Khadijah Breathett, University of Colorado, Anschutz Medical Campus, RC2, Mail Stop B139, 12700 East 19th Avenue, Room 8103, Aurora, Colorado 80045.
Objectives The aim of this study was to determine if the Affordable Care Act (ACA) Medicaid Expansion was associated with increased census-adjusted heart transplant listing rates for racial/ethnic minorities.
Background Underinsurance limits access to transplants, especially among racial/ethnic minorities. Changes in racial/ethnic listing rates post-ACA Medicaid Expansion are unknown.
Methods Using the Scientific Registry of Transplant Recipients, we analyzed 5,651 patients from early adopter states (implemented the ACA Medicaid Expansion by January 2014) and 4,769 patients from non-adopter states (no implementation during the study period) from 2012 to 2015. Piecewise linear models, stratified according to race/ethnicity, were fit to monthly census-adjusted rates of heart transplant listings before and after January 2014.
Results A significant 30% increase in the rate of heart transplant listings for African-American patients in early adopter states occurred immediately after the ACA Medicaid Expansion on January 1, 2014 (before 0.15 to after 0.20/100,000; increase 0.05/100,000; 95% confidence interval [CI]: 0.01 to 0.08); in contrast, the rates for African-American patients in non-adopter states remained constant (before and after 0.15/100,000; increase 0.006/100,000; 95% CI: –0.03 to 0.04). Hispanic patients experienced an opposite trend, with no significant change in early adopter states (before 0.03 to after 0.04/100,000; increase 0.01/100,000; 95% CI: –0.004 to 0.02) and a significant increase in non-adopter states (before 0.03 to after 0.05/100,000; increase 0.02/100,000; 95% CI: 0.002 to 0.03). There were no significant changes in listing rates among Caucasian patients in either early adopter states or non-adopter states.
Conclusions Implementation of the ACA Medicaid Expansion was associated with increased heart transplant listings in African-American patients but not in Hispanic or Caucasian patients. Broadening of the ACA in states with large African-American populations may reduce disparities in heart transplant listings.
The data reported here were supplied by the Minneapolis Medical Research Foundation as the contractor for the Scientific Registry of Transplant Recipients. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the Scientific Registry of Transplant Recipients or the U.S. government. Dr. Breathett has received support from a T32 training grant (5T32 HL116276-02) from the National Institutes of Health and the University of Colorado, Department of Medicine, Health Services Research Development Grant Award. Dr. Allen discloses grant funding from the National Institutes of Health (K23 HL105896), the Patient Centered Outcomes Research Institute (CDR-1310-06998), and the American Heart Association (#16SFRN29640000); and has served as consultant for J&J, Novartis, St. Jude, and ZS Pharma. Dr. Daugherty has received grant funding from the National Heart, Lung, and Blood Institute (K08 HL103776) and the American Heart Association (#2515963). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 18, 2016.
- Revision received October 26, 2016.
- Accepted October 26, 2016.
- American College of Cardiology Foundation