Background: The Affordable Care Act (ACA), passed in March 2010 and implemented in October 2013, sought to increase access to healthcare for non-elderly US adults. We sought to describe the impact of the ACA on the insurance status of patients with atherosclerotic cardiovascular disease (ASCVD).
Methods: We used the nationally-representative, Medical Expenditure Panel Survey database between 2006-2015 to assess trends in insurance status for patients between 18-64 years of age with ≥1 self-reported ASCVD diagnosis (coronary heart disease, myocardial infarction, angina or stroke) and a body mass index ≥18.5. Insurance status was grouped into uninsured, private insurance and Medicaid, and classified by most months covered per year. We excluded patients equally covered by >1 source and with non-Medicaid public insurance.
Results: Of the 174,526 subjects analyzed (excluded n=18262 (9.4%)) between 2006 and 2015, 4.3% (n=7504; weighted n=71.4 million) of non-elderly US adults had ASCVD. Over the period, proportion of low-income patients increased 71%, from 15.2% to 26.0% of the study population (p=0.02). The uninsured rate of non-elderly ASCVD patients increased from 15.9% in 2006 to 21.7% in 2011 followed by a reduction to 13.5% in 2015. (Figure) ASCVD patients on Medicaid increased from 12.9% in 2006 to 15.8% in 2011 (22.4% increase) before rising to 25.0% in 2015 (58.2% increase). From 2006-2015, ASCVD patients with private insurance declined steadily from 71.1% to 61.6%.
Conclusion: ACA passage and enactment were associated with a reduction in the national US ASCVD population between 18-64 years lacking insurance, with a sharp increase in Medicaid enrollment. Our study highlights the important role of the ACA in providing healthcare access to non-elderly Americans with ASCVD, particularly through Medicaid expansion.