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Invited Commentary
August 19, 2020

Affordable Care Act Medicaid Expansion and Access to Outpatient Surgical Care

Author Affiliations
  • 1Section of General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
  • 2Section of Surgical Oncology, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
JAMA Surg. 2020;155(11):1066-1067. doi:10.1001/jamasurg.2020.2974

Medicaid expansion through the Affordable Care Act (ACA) has provided insurance coverage to approximately 10 million low-income Americans since it was implemented in January 2014.1 To date, 36 states and the District of Columbia have opted to expand their Medicaid coverage. The ACA has been a boon for surgical care in Medicaid expansion states. Medicaid expansion is associated with earlier presentation for surgical conditions,2 access to rehabilitation services after trauma surgery,3 and increased use of joint replacement surgery.4 Most of the literature regarding Medicaid expansion has focused on the inpatient setting; yet, understanding the association of Medicaid expansion with outpatient surgery is important because ambulatory surgical procedures are often more cost-effective compared with procedures performed in the hospital setting,5 and low-income populations have historically had limited access to ambulatory surgery.6

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