Medicaid Expansion increased low-income patient access to kidney transplants

June 21, 2018

After states expanded Medicaid to cover more low-income individuals under the Affordable Care Act (ACA), there was a significant boost in the number of chronic kidney disease patients with Medicaid coverage who were placed on the kidney transplant waiting list, according to a new study led by Drexel University researchers.

Medicaid expansion was associated with larger increases in Medicaid coverage among new listings of racial and ethnic minority patients compared to listings of white patients. This suggests that Medicaid expansion may have helped to curb racial and socioeconomic disparities in pre-dialysis chronic kidney disease care in the United States. The findings appear in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN).

More than 93,000 people are currently listed for a new kidney, according to the U.S. Department of Health and Human Services. While black and Hispanic Americans have higher rates of diabetes and high blood pressure than white Americans, putting them at risk for organ failure, historically patients who were white or had private health insurance were more likely to receive an organ transplant.

Kidney transplantation is more cost-effective and associated with better health outcomes than dialysis. Getting on the waiting list early can shorten the amount of time that kidney transplant candidates need to endure dialysis before getting a transplant, with average waiting times of five to seven years. However, access to the list is largely dependent on having health insurance coverage, and Medicare only provides a health insurance "safety net" for individuals without other insurance coverage after they start dialysis.

"The sooner you can get on the list, the sooner you may receive a transplant. However, before the ACA, the majority of patients who got on the waiting list before starting dialysis had private health insurance and were white, even though minorities are substantially more likely than white individuals to end up with late-stage kidney disease," said the study's lead author Meera Nair Harhay, MD, an assistant professor of medicine at Drexel University College of Medicine. "Given evidence that millions of low income and minority individuals gained insurance coverage by Medicaid expansion, I wondered whether Medicaid expansion was also changing the socioeconomic and racial makeup of the kidney transplant waitlist."

January 1, 2014 marked the beginning of the full implementation of Medicaid expansion in the United States, when the federal government enhanced funding to states that elected to expand Medicaid to cover low-income adults at or below 138 percent of the federal poverty level. Using national data from the United Network of Organ Sharing database over a six-year period, Harhay and her colleagues compared trends in insurance types used for preemptive listings among U.S. states that did and did not expand Medicaid under the ACA. They also examined whether there was evidence of differences in insurance types used for preemptive listings of minorities compared to listings of white transplant candidates after Medicaid expansion

The researchers found that states that expanded their Medicaid programs experienced an increase in preemptive listings of Medicaid beneficiaries. States that fully implemented Medicaid expansion on January 1, 2014 had a 59 percent relative increase in Medicaid-covered preemptive listings (1,094 to 1,737 patients) from the pre-expansion (years 2011-2013) to post-expansion period (years 2014-2016), compared with an 8.8 percent relative increase among Medicaid non-expansion states. From the pre- to post-expansion period, the adjusted proportion of listings with Medicaid coverage increased by 3 percentage-points among expansion states and decreased by 0.3 percentage-points among non-expansion states.

"In states that did not expand Medicaid, millions of individuals with incomes too high to qualify for Medicaid and too low to receive subsidized private insurance remain uninsured," the study authors write in their conclusion. "Given this coverage gap, it is uncertain if low-income individuals with chronic kidney disease in non-expansion states have had equivalent opportunities to accrue preemptive waiting time for kidney transplantation."

The authors also found that in expansion states, the proportion of new black listings with Medicaid coverage increased by 4 percentage points, and the proportion of new Hispanic listings with Medicaid coverage increased by 5.9 percentage points, whereas the proportion of new white listings with Medicaid coverage increased by only 1.4 percentage points.

With respect to cost, the study authors note that U.S. spending for chronic dialysis currently exceeds 30 billion dollars per year.

"Policies, such as insurance expansion, that expand access to health care and kidney transplantation services for low-income patients could lessen the number of patients on dialysis and significantly reduce these costs," said study co-author Ryan McKenna, PhD, an assistant professor at Drexel's Dornsife School of Public Health.

"Our study has shown that expanding Medicaid may provide a pathway to kidney transplantation for low income individuals with kidney disease," Harhay said.

The study authors concluded that more research is needed to find out whether long-term transplant outcomes differ among candidates who were listed with expanded Medicaid coverage compared with those with other coverage options.
-end-


Drexel University

Related Kidney Disease Articles from Brightsurf:

Waistline matters in kidney disease
Does fat matter in kidney disease? The investigators found that all measures of higher abdominal fat content (including visceral fat, liver fat, or subcutaneous fat) and slower walk times were associated with increased levels of cardiometabolic risk factors in adults with non-dialysis dependent kidney disease.

Reducing urinary protein for patients with rare kidney disease slows kidney decline
New findings show that reducing the amount of protein in the urine of patients with focal segmental glomerulosclerosis can significantly slow declines in kidney function and extend time before patients' kidneys fail.

Antioxidant agent may prevent chronic kidney disease and Parkinson's disease
Researchers from Osaka University developed a novel dietary silicon-based antioxidant agent with renoprotective and neuroprotective effects.

Acute kidney injury and end stage kidney disease in severe COVID-19
Many COVID-19 patients experience hematuria, proteinuria and elevated serum creatinine concentration early in the course of the disease.

Genes tell a story about diabetic kidney disease
Studying Finnish genes leads to unique revelations about the development of a serious complication of diabetes, and informs an ongoing genomic study of a Singaporean cohort as part of Singapore's Diabetes Study in Nephropathy and other Microvascular Complications (DYNAMO).

New study provides insight into chronic kidney disease
Researchers have further analyzed a known signaling pathway they believe brings them one step closer to understanding the complex physiology of patients with chronic kidney disease (CKD), which might provide a path to new treatment options.

Predicting risk of chronic kidney disease
Data from about 5 million people (with and without diabetes) in 28 countries were used to develop equations to help identify people at increased five-year risk of chronic kidney disease, defined as reduced estimated glomerular filtration rate (eGFR).

A healthy diet may help prevent kidney disease
In an analysis of published studies, a healthy dietary pattern was associated with a 30% lower incidence of chronic kidney disease.

Is kidney failure a man's disease?
A new analysis of the ERA-EDTA Registry [1] reveals a striking gender difference in the incidence and prevalence of end-stage renal disease.

Chronic kidney disease: Everyone's concern
850 million people worldwide are affected by kidney disease. This worrying figure was published last June.

Read More: Kidney Disease News and Kidney Disease Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.