The Affordable Care Act Medicaid Expansion Correlated With Increased Heart Transplant Listings in African-Americans But Not Hispanics or Caucasians

JACC Heart Fail. 2017 Feb;5(2):136-147. doi: 10.1016/j.jchf.2016.10.013. Epub 2017 Jan 18.


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.

Keywords: health care policy; insurance; racial disparities.

MeSH terms

  • Adolescent
  • Adult
  • African Americans / statistics & numerical data*
  • Aged
  • Female
  • Healthcare Disparities / ethnology
  • Heart Failure*
  • Heart Transplantation*
  • Hispanic or Latino / statistics & numerical data*
  • Humans
  • Insurance Coverage
  • Insurance, Health
  • Linear Models
  • Male
  • Medicaid*
  • Medically Uninsured
  • Middle Aged
  • Patient Protection and Affordable Care Act*
  • United States
  • Waiting Lists*
  • Whites / statistics & numerical data*
  • Young Adult