Abstract: TH-PO815

Effects of the Affordable Care Act (ACA) and Medicaid Expansion on Incident ESRD Patients

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Hirth, Richard A., University of Michigan, Ann Arbor, Michigan, United States
  • Steffick, Diane, University of Michigan, Ann Arbor, Michigan, United States
  • Pearson, Jeffrey, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Hutton, David W., University of Michigan, Ann Arbor, Michigan, United States
  • Herman, William H., University of Michigan, Ann Arbor, Michigan, United States
  • Shahinian, Vahakn B., University of Michigan, Ann Arbor, Michigan, United States
  • Ayanian, John Z., University of Michigan, Ann Arbor, Michigan, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
Background

The expansion of insurance coverage under the ACA may have improved access to pre-ESRD care in the United States through the health insurance exchanges and the expansion of the Medicaid program. We assessed whether changes in insurance status at onset of ESRD were accompanied by changes in markers of pre-ESRD care.

Methods

Data were from the CMS Medical Evidence Form 2728. Patients whose first dialysis treatment occurred before the ACA’s insurance expansions (10/1/11-12/31/13) were compared to patients incident after the ACA (1/1/14-3/31/16). A difference-in-difference approach was utilized to control for background trends in populations not likely to be affected by the ACA. The primary pre- vs. post-ACA comparisons were: 1) patients <65 years old with no Medicare coverage vs. patients 66+ with coverage, and 2) patients <65 in states expanding Medicaid on 1/1/14 vs. patients <65 in states that did not expand.

Results

Overall, the percent of patients <65 uninsured at incidence fell from 17.6% pre-ACA to 11.3% post-ACA [Figure]. Relative to trends for patients 66+, among patients <65, 6.2% saw gain in insurance coverage, 1.6% had gain in pre-ESRD nephrology care, 1.7% increased to use of home dialysis, and 1.4% showed a slower decline in use of EPO, but no improvement in vascular access type. Relative to trends for patients <65 in non-Medicaid expansion states, those in expansion states had a 3.4% gain in insurance, 1.1% gain in pre-ESRD nephrology care, 1.7% gain in fistula-in-use or maturing, but no change in EPO or home dialysis.

Conclusion

The ACA improved insurance coverage for patients initiating dialysis in the US, and increased many but not all markers of pre-ESRD care.

Impact of the Affordable Care Act (ACA) on Incident ESRD Patients

Funding

  • NIDDK Support