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Fewer Late-Stage Kidney Deaths After Obamacare: Study

MONDAY, Nov. 5, 2018 -- End-stage kidney disease patients on dialysis are among those benefiting from Obamacare's expansion of Medicaid, with related deaths declining in states that increased the program's enrollment, research suggests.

Researchers followed more than 230,000 non-elderly kidney failure patients undergoing dialysis treatment in the United States between 2011 and 2017.

Under the Affordable Care Act, also known as Obamacare, 25 states and the District of Columbia in January 2014 extended Medicaid, the publicly funded insurance program for the poor. Since then, eight more states have expanded Medicaid.

"To my knowledge, this is the first study to find an association between Medicaid expansion under the ACA and lower death rates in adults," said senior author Dr. Amal Trivedi, an associate professor at Brown University's School of Public Health in Providence, R.I.

"Prior research on the effects of Medicaid expansion have generally found that expansion is associated with substantial gains in coverage, access to care, use of preventive health services and in some studies, better self-rated health," Trivedi said in a university news release.

In states that expanded Medicaid, the percentage of kidney failure patients who died their first year on dialysis decreased from nearly 7 percent before expansion to just over 6 percent after expansion, the study found.

In non-expansion states, the death rate fell from 7 percent to 6.8 percent, according to the study.

The adjusted absolute reduction in deaths in expansion states versus non-expansion states was 0.6 percentage points. Since kidney failure affects more than 100,000 Americans each year, 0.6 percentage points equals hundreds of patients a year, according to Trivedi.

Medicaid expansion led to a decrease in kidney failure patients without insurance by 4.2 percentage points, the researchers said.

"Multiple factors not explored in our paper may have contributed to the reduction of mortality among patients with end-stage renal disease," said study lead author Shailender Swaminathan, an adjunct assistant professor at Brown's School of Public Health.

"Medicaid may have resulted in better adherence to treatment sessions, normally three times a week, because it eliminated copayments of about $150 per week," Swaminathan said.

"On the other hand, because out-of-pocket medical payments were reduced, Medicaid may have also improved patients' finances, thereby improving health. More research may be essential to unravel this," he said.

The findings were published recently in the Journal of the American Medical Association.

© 2020 HealthDay. All rights reserved.

Posted: November 2018

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