Health Services/Policy
Medicaid Expansion Among Non-Elderly Adults and Cardiovascular Outcomes: A Distributional Cost-Effectiveness Analysis Luke Barry* Luke Barry Roch Nianogo
Introduction
Evidence suggests Medicaid expansion has improved CVD outcomes, especially among lower SES groups. It remains unclear what the implications are of Medicaid expansion for cost-effectiveness and CVD disparities.
Methods
A Monte Carlo Markov-chain microsimulation model was developed to examine changes in CVD outcomes as a result of Medicaid expansion and the distributional cost and quality-of-life impacts.
Results
Medicaid expansion was associated with a reduction of 14 (SE: 3) myocardial infarctions, 12 (3 strokes, and 6 (2) CVD deaths per 100,000 person-years compared to no expansion with the largest reductions occurring for those with lower income and education, and those of Black and Hispanic race/ethnicity. Medicaid expansion was considered cost-effective from a healthcare perspective (Incremental Net Health Benefit [INHB] = 0.055 [SE = 0.0045]) but not cost-effective from a societal perspective (INHB = -0.004 [SE = 0.0035]); using a value of $100,000 per QALY. The most influential variables for cost-effectiveness were: the increase in total healthcare costs among those who received Medicaid; the cost of Medicaid administration per enrollee; the discount rate; and the change in systolic blood pressure from receiving Medicaid.. The targeting of Medicaid expansion to lower income groups helped reduce net health disparities according to family income and education.
Conclusion
Medicaid expansion reduced net health disparities across family income and education groups. It was cost-effective from a healthcare perspective, by improving health and reducing out-of-pocket costs for individuals, and reducing uncompensated care costs for hospitals, but not cost-effective from a societal perspective.
Figure: Incremental Net Health Benefit (WTP = $100,000) per-person for the base-case scenario across equity-relevant groups
