title: The Affordable Care Act Medicaid Expansion Correlated With Increased Heart Transplant Listings in African-Americans But Not Hispanics or Caucasians.
abstract: 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.
  
  
  
  Underinsurance limits access to transplants, especially among racial/ethnic minorities. Changes in racial/ethnic listing rates post-ACA Medicaid Expansion are unknown.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: University of Colorado, Anschutz Medical Campus, Division of Cardiology, Aurora, Colorado. Electronic address: khadijah.breathett@ucdenver.edu.
authors.forename: Khadijah
authors.initials: K
authors.lastname: Breathett
authors.affiliation: University of Colorado, Anschutz Medical Campus, Division of Cardiology, Aurora, Colorado.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.affiliation: University of Colorado Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, Colorado.
authors.forename: Laura
authors.initials: L
authors.lastname: Helmkamp
authors.affiliation: University of Colorado Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, Colorado.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Colborn
authors.affiliation: University of Colorado, Anschutz Medical Campus, Division of Cardiology, Aurora, Colorado.
authors.forename: Stacie L
authors.initials: SL
authors.lastname: Daugherty
authors.affiliation: University of Colorado, Anschutz Medical Campus, Division of Cardiology, Aurora, Colorado.
authors.forename: Prateeti
authors.initials: P
authors.lastname: Khazanie
authors.affiliation: University of Colorado, Department of Health Systems, Management and Policy in the Colorado School of Public Health, Aurora, Colorado.
authors.forename: Richard
authors.initials: R
authors.lastname: Lindrooth
authors.affiliation: University of Colorado, Anschutz Medical Campus, Division of Cardiology, Aurora, Colorado; Denver Health Medical Center, Denver, Colorado.
authors.forename: Pamela N
authors.initials: PN
authors.lastname: Peterson
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology; D006333:Heart Failure; D016027:Heart Transplantation; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D016014:Linear Models; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D014481:United States; D014850:Waiting Lists; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: health care policy; insurance; racial disparities