Abstract
Background: Healthcare expenditures among stroke patients are high and expected to rise over time as the population in the United States ages. However, there are limited contemporary data on the nationwide economic impact of stroke especially in the era of the Affordable Care Act (ACA). Objective: To evaluate temporal trends of stroke-related healthcare expenditures before and after the ACA, which was signed into law on March 23, 2010. Methods: We identified 9,351(4.2%) adults with stroke aged ≥18 years from 2003-2014 Medical Expenditure Panel Survey (MEPS) data. Stroke was identified using ICD-9 code of 431, 433, 434, 436 and 438 as well as self-reported surveys. We used ‘margins’ post estimation command following the adjusted GLM to estimate the predicted mean of healthcare expenditure for Pre ACA vs Post ACA among adults with stroke. Results: Prevalence of stroke in the United States increased from 3.60% in the pre-ACA era to 4.39% in the post-ACA era (P<0.0001). The adjusted predicted mean of healthcare expenditures per year during the Pre-ACA period was $9,653 (95% CI $8,627-$10,679) compared with the Post-ACA period of $9,339 (95% CI $8,153-$10,525) among adults with stroke, which corresponded to a non-significant $317 (95% CI: -$1,161-$525) decrease in healthcare expenditure. On the other hand, pre-ACA vs. post-ACA overall mean healthcare expenditure in the US significantly increased from $5,339 (95% CI: $5,211-5,466) to $5,750 (95% CI: 5,598-5902). Conclusions: Direct healthcare expenditures for stroke patients were reduced after the introduction of the ACA, but not to a significant degree. The lack of a significant effect of the ACA on direct stroke expenditures from 2010-2014 may have been due to an increase in the prevalence of stroke, a background increase in overall healthcare expenditures, more time needed to see an effect, or weaknesses in the law itself. Further study is warranted.
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