{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T10:13:41Z","timestamp":1773828821477,"version":"3.50.1"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>The Affordable Care Act (ACA) has been associated with increased heart transplant listings among blacks, who are disproportionately uninsured. It is unclear whether the ACA is also associated with increased ventricular assist device implantation in blacks.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Using Healthcare Cost and Utilization Project Data State Inpatient Databases from 19 states and Washington DC, we analyzed 1157 patients from early-adopter states (ACA Medicaid expansion by January 2014) and 785 patients from nonadopter states (no implementation from 2013 to 2014). Piecewise Poisson regression with a discontinuity was used to estimate change in census-adjusted rates of ventricular assist device implants by race and ACA adopter status 1 year before and after January 2014.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Following the ACA Medicaid expansion, the proportional change in rate increased significantly among blacks from early adopter (1.40 [95% CI, 1.12\u20131.75], pre 0.57\/100 000 to post-ACA 0.80\/100 000) but not nonadopter states (1.25 [95% CI, 0.98\u20131.58], pre 0.40\/100 000 to post-ACA 0.50\/100 000). However, the early and nonadopter changes in implantation rates were not statistically different from each other (\n              <jats:italic>P<\/jats:italic>\n              =0.50). There were no immediate changes in whites in either state group following the ACA Medicaid expansion (early adopter, 1.12 [95% CI, 0.98\u20131.29], pre 0.27\/100 000 to post-ACA 0.30\/100 000; nonadopter, 0.98 [95% CI, 0.82\u20131.16], pre 0.27\/100 000 to post-ACA 0.26\/100 000).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Among eligible states participating in Healthcare Cost and Utilization Project Data State Inpatient Databases, the ACA was not associated with immediate changes in ventricular assist device implantation rates by race. Although a significant increase in implantation rate was observed among blacks from early-adopter states, the change was not statistically different from the change seen in nonadopter states.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.119.006544","type":"journal-article","created":{"date-parts":[[2020,4,1]],"date-time":"2020-04-01T09:00:29Z","timestamp":1585731629000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Is the Affordable Care Act Medicaid Expansion Linked to Change in Rate of Ventricular Assist Device Implantation for Blacks and Whites?"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5397-6419","authenticated-orcid":false,"given":"Khadijah K.","family":"Breathett","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Sarver Heart Center (K.K.B., N.K.S), University of Arizona, Tucson."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shannon M.","family":"Knapp","sequence":"additional","affiliation":[{"name":"Statistics Consulting Lab, Bio5 Institute (S.M.K.), University of Arizona, Tucson."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Wightman","sequence":"additional","affiliation":[{"name":"Center for Population Sciences (P.W., E.C.), University of Arizona, Tucson."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Archita","family":"Desai","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Indiana University, Indianapolis (A.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sula","family":"Mazimba","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Virginia, Charlottesville (S.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Calhoun","sequence":"additional","affiliation":[{"name":"Center for Population Sciences (P.W., E.C.), University of Arizona, Tucson."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy K.","family":"Sweitzer","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Sarver Heart Center (K.K.B., N.K.S), University of Arizona, Tucson."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000659"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.02.042"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.118.005008"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2012.09.013"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.0757"},{"key":"e_1_3_4_7_2","unstructured":"Key Facts about the Uninsured Population. The Henry J. Kaiser Family Foundation. Available at: https:\/\/www.kff.org\/uninsured\/fact-sheet\/key-facts-about-the-uninsured-population. 2018. Accessed Jun 10 2019."},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2016.10.013"},{"key":"e_1_3_4_9_2","unstructured":"HCUP-US SID Overview. https:\/\/www.hcup-us.ahrq.gov\/sidoverview.jsp. Accessed June 10 2019."},{"key":"e_1_3_4_10_2","unstructured":"The Henry J. Kaiser Family Foundation. Status of State Action on the Medicaid Expansion Decision. https:\/\/www.kff.org\/health-reform\/state-indicator\/state-activity-around-expanding-medicaid-under-the-affordable-care-act. Accessed Sep 28 2018."},{"key":"e_1_3_4_11_2","volume-title":"R: A language and environment for statistical computing","author":"R Core Team","year":"2018","unstructured":"R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2018. Available at: https:\/\/www.R-project.org\/."},{"key":"e_1_3_4_12_2","unstructured":"Key Features of the Affordable Care Act By Year. ASPA. Available at: http:\/\/www.hhs.gov\/healthcare\/facts\/timeline\/timeline-text.html. 2013. Accessed Aug 19 2015."},{"key":"e_1_3_4_13_2","unstructured":"Artiga S Orgera K Damico A; The Henry J. Kaiser Family Foundation. Changes in health coverage by race and ethnicity since implementation of the ACA 2013-2017. https:\/\/www.kff.org\/disparities-policy\/issue-brief\/changes-in-health-coverage-by-race-and-ethnicity-since-implementation-of-the-aca-2013-2017\/. Published February 13 2019. Accessed Jan 29 2020."},{"key":"e_1_3_4_14_2","first-page":"1","article-title":"Reducing racial and ethnic disparities in access to care: has the affordable care act made a difference?","volume":"2017","author":"Hayes SL","year":"2017","unstructured":"Hayes, SL, Riley, P, Radley, DC, McCarthy, D. Reducing racial and ethnic disparities in access to care: has the affordable care act made a difference? Issue Brief (Commonw Fund). 2017;2017:1\u201314.","journal-title":"Issue Brief (Commonw Fund)"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.1651"},{"key":"e_1_3_4_16_2","unstructured":"Arellano AR de Wolfe S. Unsettling Scores A Ranking of State Medicaid Programs. http:\/\/www.citizen.org\/hrg1807#national_results. 2007. Accessed May 3 2016."},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13328"},{"key":"e_1_3_4_18_2","unstructured":"Covered Transplants And Related Immunosuppressant Medications. 2014. https:\/\/www.azahcccs.gov\/shared\/Downloads\/MedicalPolicyManual\/310DD.pdf. Accessed June 23 2019."},{"key":"e_1_3_4_19_2","unstructured":"Decision Memo for Ventricular Assist Devices for Bridge-to-Transplant and Destination Therapy (CAG-00432R). https:\/\/www.cms.gov\/medicare-coverage-database\/details\/nca-decision-memo.aspx?NCAId=268. Accessed Jan 3 2018."},{"key":"e_1_3_4_20_2","first-page":"583","article-title":"On medicaid and the affordable care act in connecticut: the problem with subspecialty services.","volume":"87","author":"Manthous CA","year":"2014","unstructured":"Manthous, CA, Sofair, AN. On medicaid and the affordable care act in connecticut: the problem with subspecialty services. Yale J Biol Med. 2014;87:583\u2013591.","journal-title":"Yale J Biol Med"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.9375"},{"key":"e_1_3_4_22_2","unstructured":"Doctors Hospitals Say \u201cNo\u201d to Obamacare Plans. US News & World Report. https:\/\/www.usnews.com\/news\/articles\/2015\/11\/04\/doctors-hospitals-wont-accept-obamacare-marketplace-plans. Published November 4 2015. Accessed Jun 23 2019."},{"key":"e_1_3_4_23_2","unstructured":"Musumeci M Hinton E Rudowitz R. Section 1115 medicaid expansion waivers: a look at key themes and state specific waiver provisions. August 2017. http:\/\/files.kff.org\/attachment\/Issue-Brief-Section-1115-Medicaid-Expansion-Waivers-A-Look-at-Key-Themes-and-State-Specific-Waiver-Provisions. 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