Medicaid Expansion and Surgical Care—Evaluating the Evidence

The 2010 Affordable Care Act (ACA) has led to the most significant increase in health insurance coverage in the past 50 years. The expansion of Medicaid eligibility to nonelderly adults with incomes less than 138% of the federal poverty level has extended health insurance to more than 13 million previously uninsured individuals in the US.¹ However, in the setting of recent efforts to curtail Medicaid expansion, the number of uninsured individuals in the US has started to increase again since its nadir in 2016. Combined with the economic and political upheaval surrounding the current coronavirus disease 2019 (COVID-19) pandemic, insurance coverage gains and losses have the potential to significantly impact the health and wellness of lower-income patients in need of surgical care. This Viewpoint considers recent evidence regarding the impact of Medicaid expansion—and, by extension, the potential impact of its reversal—on insurance coverage, access to care, processes of care, health outcomes, and financial risk protection among surgical patients.