Anticipating the Effects of Medicaid Expansion on Surgical Care

Abstract

TO THE EDITOR: The Affordable Care Act (ACA) 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 impact 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 the ACA also mandates a reduction in payments to disproportionate share hospitals (DSH),4 increased Medicaid enrollment could have substantial clinical and financial implications for hospitals facing expansion. To better understand this change, we examined the surgical outcomes and resource use of Medicaid patients in Michigan the year prior to implementation of the ACA using a statewide clinical registry.