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Research Letter |

Anticipating the Effects of Medicaid Expansion on Surgical Care

Seth A. Waits, MD1; Bradley N. Reames, MD, MS1; Kyle H. Sheetz, MS1; Michael J. Englesbe, MD1; Darrell A. Campbell Jr, MD1
[+] Author Affiliations
1Section of General Surgery, Department of Surgery, University of Michigan, Ann Arbor
JAMA Surg. 2014;149(7):745-747. doi:10.1001/jamasurg.2014.222.
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The Affordable Care Act expanded Medicaid coverage to adults with incomes up to 133% of the federal poverty level, but a subsequent Supreme Court ruling determined Congress could give states the option to expand. In September of 2013, the state of Michigan approved expansion. Beginning in April 2014, more than 400 000 adults will be newly eligible for Medicaid enrollment in the state.1

The effect of this influx of patients on surgical care and hospital costs in Michigan is unknown. Previous national studies of Medicaid patients undergoing surgery have shown worse outcomes2 and increased costs.3 Given that the Affordable Care Act also mandates a reduction in payments to disproportionate share hospitals,4 increased Medicaid enrollment could have substantial clinical and financial implications for hospitals facing expansion. To better understand this change, using a statewide clinical registry, we examined the surgical outcomes and resource use of Medicaid patients in Michigan the year prior to implementation of the Affordable Care Act.

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Figure.
Proportion of Medicaid Patients Treated by Each of Michigan’s 52 Hospitals (A) and Percentage of Total Medicaid Volume Treated Within Each Hospital Quintile (B)

Data obtained for the period from July 2012 to June 2013. Error bars indicate 95% CIs.

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