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Research Letter
September 2016

Implementation of the Affordable Care Act and Solid-Organ Transplantation Listings in the United States

Author Affiliations
  • 1Advanced Heart Failure Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
JAMA Cardiol. 2016;1(6):737-738. doi:10.1001/jamacardio.2016.2067

The Affordable Care Act (ACA) was designed to facilitate health care access for underinsured and uninsured patients via Medicaid expansion and the insurance exchange market.1 As of September 2015, an estimated 17.6 million individuals enrolled through the ACA, with a total 35% reduction in the number of uninsured.2 Because heart transplantation in the United States has largely excluded uninsured patients,3 we hypothesized that implementation of the ACA would result in increased transplant listings. We therefore investigated patterns of heart, liver, and kidney listings related to the implementation of the ACA.

Using the United Network for Organ Sharing registry, we compared listings for heart, liver, and kidney transplantation during identical periods before (from January 1, 2012, to September 30, 2013)4 and after implementation of the ACA (from January 1, 2014, to September 30, 2015) in states that adopted Medicaid expansion (n = 25, including the District of Columbia) or did not adopt Medicaid expansion (n = 21). Five states were excluded because Medicaid expansion was implemented after January 1, 2014.4 Percent changes of listed patients were compared using the χ2 test, with P < .05 considered statistically significant. Institutional review board approval was waived because the data in the United Network for Organ Sharing are public and deidentified.