New study shows Massachusetts health reform did not reduce barriers to heart related procedures

In a new article published in American Heart Association’s journal “Circulation,” researchers from Brigham and Women’s Hospital and Howard University of Medicine examined hospital claims data and found that Massachusetts health insurance expansion did not have impact whether an individual aged 21 – 64 received coronary treatments by ethnicity, gender, or socioeconomic status. Data for more than 44,937 discharges related to heart disease was analyzed, with 82% categorized as white, 4.1% Black, 4.8% Hispanic, 1.3% Asian, and 7.8% patients with missing or other race/ethnicity.

In particular:

• For Black and Latino populations, there was no difference in likelihood to receive coronary revascularization (an important procedure that restores blood flow through the heart, such as bypass) 1-year post-health reform (30% and 16%, respectively). These communities were also less likely than the white population to receive this procedure. In this study, Asians (29%) were more likely to receive this procedure compared to whites post-health reform, which conflicts with previous literature.

• Patients residing in areas that had a higher proportion of high school graduates were more likely to receive coronary revascularizations pre- and post-reform.

These findings are important, especially in the midst of the Affordable Care Act implementation, as this study provided early evidence that insurance expansion did not reduce barriers in receiving procedures like coronary revascularization. Furthermore, this study provided further evidence that insurance expansion alone does not eliminate health disparities as it relates to race/ethnicity and socioeconomic status. The authors recommend interventions to focus more on subgroups and for continued efforts to address disparities shaped by social determinants of health.

Joanne Chan, Joint Center Graduate Scholar, Harvard School of Public Health