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Impact of Health Insurance Expansions on Nonelderly Adults With Hypertension

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Impact of Health Insurance Expansions on Nonelderly Adults With Hypertension



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Impact of Health Insurance Expansions on Nonelderly Adults With Hypertension

ORIGINAL RESEARCH — Volume 12 — July 2, 2015

Suhui Li, PhD; Brian K. Bruen, MS; Paula M. Lantz, PhD; David Mendez, PhD

Suggested citation for this article: Li S, Bruen BK, Lantz PM, Mendez D. Impact of Health Insurance Expansions on Nonelderly Adults With Hypertension. Prev Chronic Dis 2015;12:150111. DOI:http://dx.doi.org/10.5888/pcd12.150111.
PEER REVIEWED

Abstract

Introduction
Hypertension is a risk factor for cardiovascular disease (CVD), the leading cause of death in the United States. The treatment and control of hypertension is inadequate, especially among patients without health insurance coverage. The Affordable Care Act offered an opportunity to improve hypertension management by increasing the number of people covered by insurance. This study predicts the long-term effects of improved hypertension treatment rates due to insurance expansions on the prevalence and mortality rates of CVD of nonelderly Americans with hypertension.
Methods
We developed a state-transition model to simulate the lifetime health events of the population aged 25 to 64 years. We modeled the effects of insurance coverage expansions on the basis of published findings on the relationship between insurance coverage, use of antihypertensive medications, and CVD-related events and deaths.
Results
The model projected that currently anticipated health insurance expansions would lead to a 5.1% increase in treatment rate among hypertensive patients. Such an increase in treatment rate is estimated to lead to 111,000 fewer new coronary heart disease events, 63,000 fewer stroke events, and 95,000 fewer CVD-related deaths by 2050. The estimated benefits were slightly greater for men than for women and were greater among nonwhite populations.
Conclusion
Federal and state efforts to expand insurance coverage among nonelderly adults could yield significant health benefits in terms of CVD prevalence and mortality rates and narrow the racial/ethnic disparities in health outcomes for patients with hypertension.
Simplified diagram of the Markov process. Abbreviation: CHD, coronary heart disease; CVD, cardiovascular disease; MI, myocardial infarction
Figure 1. Simplified diagram of the Markov process. Abbreviation: CHD, coronary heart disease; CVD, cardiovascular disease; MI, myocardial infarction. [A text description of this figure is also available.]




Estimated reduction in cardiovascular events and mortality rates under insurance expansions for white, black, and nonwhite Hispanic populations, by age group.
Figure 2. Estimated reduction in cardiovascular events and mortality rates under insurance expansions for white, black, and nonwhite Hispanic populations, by age group. These charts illustrate the racial/ethnic-specific effects of insurance coverage expansion by age group. Outcomes are measured by percentage reduction in cardiovascular events and mortality rates. Scenario 1 assumes currently undecided states opting out of Medicaid expansion, and scenario 2 assumes the entire US population is covered by insurance. [A tabular description of this figure is also available.]

Acknowledgments

This study was supported by the American Heart Association. The conclusions and opinions expressed herein are solely those of the authors and do not necessarily reflect the opinions of the American Heart Association or the authors’ affiliations.
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Author Information

Corresponding Author: Suhui Li, PhD, Milken Institute School of Public Health, Department of Health Policy and Management, The George Washington University, 950 New Hampshire Ave, NW, Washington, DC 20052. Telephone: 202-994-3120. Email: suhuili@gwu.edu.
Author Affiliations: Brian K. Bruen, Paula M. Lantz, Department of Health Policy and Management, The George Washington University, Washington, DC; David Mendez, Department of Health Management and Policy, The University of Michigan, Ann Arbor, Michigan.
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