Affordable Care Act Repeal May Undo Reduced Heart Transplant Disparities

Heart transplant disparities have improved since the adoption of the ACA; if the law is repealed, experts fear these disparities will return.
Heart transplant disparities have improved since the adoption of the ACA; if the law is repealed, experts fear these disparities will return.

With uncertainty surrounding the fate of the Patient Protection and Affordable Care Act (ACA) under the new presidential administration, data continue to support positive outcomes associated with its implementation. For example, racial and ethnic disparities in insurance coverage have begun to decrease, and 133 million Americans with preexisting conditions now have coverage.1,2

"The ACA is imperfect but has reduced the uninsured population in the United States significantly," said Khadijah Breathett, MD, an advanced heart failure/transplant cardiologist and outcomes research fellow at the University of Colorado Anschutz Medical Campus in Aurora. "Now 20 million people across all races and ethnicities who were previously uninsured have healthcare insurance," she told Cardiology Advisor.3

A new study by Dr Breathett and colleagues compared changes in rates of heart transplant listings in states that had implemented ACA Medicaid Expansion at the time of the study (early adopters) vs those that had not (nonadopters).4 Their results showed that in the early-adopter states, there was a 30% increase in listing rates for African Americans, a population that has disproportionately high rates of heart failure coupled with disproportionately low transplant rates. Meanwhile, no change in rates was observed in states that had not implemented the expansion at the time of the study.

Underinsurance has previously been cited as a significant reason for the racial and ethnic disparities in transplant allocation, and Dr Breathett's findings suggest that further ACA expansion could help close the gap.5,6 However, if the law is repealed by the new administration, it stands to reason that such gains could be lost. "In our study, we found that partial implementation of this policy correlated with reduction of racial disparities in heart transplant listings among African Americans," said Dr Breathett. "The abrupt dissolution of a policy without formalized plans to build upon current knowledge may lead to levels of health inequity beyond what was present prior to implementation of the Affordable Care Act."

Results of a recent survey suggest most physicians do not support a repeal of the ACA, with only 15% of primary care physicians calling for full repeal.7 Approximately 74% of those surveyed would like to see changes in the law, including the creation of policies that would create more consumer choices regarding insurance plans.7 These and other revisions are supported by the founder of the ACA, former President Barack Obama.

In an article published in the New England Journal of Medicine, Mr Obama advocates making improvements to the law to address challenges "such as a lack of choice in some health insurance markets, premiums that remain unaffordable for some families, and high prescription-drug costs"2

However, Mr Obama warns about the risks of repealing the ACA without a replacement intact, which is what Republican congressional leaders intend to do. "If a repeal with a delay is enacted, the health care system will be standing on the edge of a cliff, resulting in uncertainty and, in some cases, harm beginning immediately." He notes, for instance, that insurers may not even wish to participate in the Health Insurance Marketplace at a later time or may raise their prices in the interim.

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