Medicaid Expansion Among Nonelderly Adults and Cardiovascular Disease: Efficiency Vs. Equity

Context: Evidence suggests Medicaid expansion has improved cardiovascular disease (CVD) outcomes, especially among those of lower socioeconomic status. However, less is known about the cost-effectiveness of Medicaid in achieving these outcomes and reducing CVD disparities. We use distributional cost-effectiveness analysis methods to examine the efficiency and equitability of Medicaid expansion in reducing CVD outcomes.

Methods: A Monte Carlo Markov-chain microsimulation model was developed to examine lifetime changes in CVD outcomes and disparities as a result of expansion and the associated cost and quality-of-life impacts.

Findings: Medicaid expansion was associated with a reduction of 11 myocardial infarctions, eight strokes, and four CVD deaths per 100,000 person-years compared with no expansion. The largest reductions occurred for those with lower income and education, and those of Black and Hispanic race/ethnicity. We found that the benefits of expansion generally balanced out the costs while redistributing health from higher to lower income groups. In probabilistic sensitivity analysis, we found—using a health opportunity cost threshold of $150,000—that Medicaid expansion was cost-effective in reducing CVD outcomes 53% of the time and both cost-effective (efficient) and equity enhancing 26% to 29% of the time.

Conclusions: Medicaid expansion resulted in a reduction in CVD incidence, suggesting that it was both cost-effective and equity enhancing in reducing CVD outcomes but with a high degree of uncertainty.