Study Highlights:

  • Counties in states that expanded Medicaid had a small but significantly lower cardiovascular mortality rate compared to areas that didn't expand Medicaid.
  • The beneficial effect was highest in nonmetropolitan counties and those with high poverty rates.

Embargoed until 9:45 a.m. CT/10:45 a.m. ET, Friday, April 5, 2019

ARLINGTON, Virginia, April 5, 2019 — Counties in states that expanded Medicaid coverage under the Affordable Care Act had fewer deaths annually from heart disease compared to areas that did not expand Medicaid, according to preliminary research presented at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2019, a premier global exchange of the latest advances in quality of care and outcomes research in cardiovascular disease and stroke for researchers, healthcare professionals and policymakers.

Medicaid expansion under the Affordable Care Act (ACA) of 2014 led to one of the largest gains in health insurance coverage for non-elderly adults in the United States. Because cardiovascular disease and risk factors have a higher prevalence in uninsured people, researchers wanted to determine if Medicaid expansion had any meaningful effect in that population by studying whether trends in cardiovascular mortality for middle-aged adults differed between states that did and did not expand Medicaid.

“This is one of the first large studies of its type to show that, with this round of Medicaid expansion, there might have been a population level mortality benefit for patients with cardiovascular disease,” said Sameed Ahmed M. Khatana, M.D., a fellow in Cardiovascular Disease at the Hospital of the University of Pennsylvania in Philadelphia. “We believe these findings will be helpful for policymakers and health policy researchers in trying to tease out the impact of this most recent round of expansion.”

The researchers used data from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research mortality database to obtain county-level cardiovascular mortality rates for all individuals 45 to 64 years of age from 2010 to 2016. They used data from all states except Massachusetts and Wisconsin, which expanded Medicaid independently of the ACA. As of 2016, 29 states and the District of Columbia had expanded Medicaid eligibility, while 19 states had not. A total of 1,960 counties were included.

The researchers found:

  • There was an increase in health insurance coverage for low-income residents in counties in expansion states (19.8 percent) compared with counties in non-expansion states (13.5 percent).

  • Counties in states that expanded Medicaid had about four fewer deaths from heart disease per hundred thousand residents compared to states that didn't expand Medicaid, which translates to approximately 1,800 fewer deaths per year in the areas that expanded Medicaid.

  • Counties with more residents living in poverty seemed to benefit most from the effect of the expansion.

The researchers also found counties that had the smallest increases in insurance coverage from 2010 to 2016 had the largest increases in cardiovascular death rates.

“We can't necessarily say from our study that giving a person health insurance through Medicaid will save their life,” Khatana said. “However, our study does show that there perhaps were at least widespread benefits concentrated in certain groups, such as those uninsured or people with higher risk of cardiovascular disease, although we can’t say for sure it was a direct result of the Medicaid expansion.”

Co-authors are Anjali Bhatla, Ashwin S. Nathan, M.D.; Jay Giri, M.D.; Changyu Shen, Ph.D.; Dhruv S. Kazi, M.D.; Robert W. Yeh, M.D.; and Peter W. Groeneveld, M.D.  Author disclosures are on the abstract.

Dr. Khatana reports there was no funding specific to this study.

Note: Scientific presentation is 11:25 a.m. ET, Friday, April 5, 2019.

Additional Resources:


Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at

About the American Heart Association

The American Heart Association is a leading force for a world of longer, healthier lives. With nearly a century of lifesaving work, the Dallas-based association is dedicated to ensuring equitable health for all. We are a trustworthy source empowering people to improve their heart health, brain health and well-being. We collaborate with numerous organizations and millions of volunteers to fund innovative research, advocate for stronger public health policies, and share lifesaving resources and information. Connect with us on, Facebook, Twitter or by calling 1-800-AHA-USA1.

For Media Inquiries and AHA Expert Perspective: 214-706-1173

Cathy Lewis: 214-706-1324;

For Public Inquiries: 1-800-AHA-USA1 (242-8721) and