{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:15:17Z","timestamp":1777936517204,"version":"3.51.4"},"reference-count":37,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T00:00:00Z","timestamp":1712880000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Department of Medicine Scholarship Enhancement in Academic Medicine Award Program, Dartmouth-Hitchcock Medical Center"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Med"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:p>Background: In 2014, the Affordable Care Act Medicaid Expansion (ME) increased Medicaid eligibility for adults with an income level up to 138% of the federal poverty level. In this study, we examined the impact of ME on mortality and amputation in patients with peripheral artery disease (PAD). Methods: The 100% MedPAR and Part-B Carrier files from 2011 to 2018 were queried to identify all fee-for-service Medicare beneficiaries with PAD using International Classification of Diseases codes. Our primary exposure was whether a state had adopted the ME on January 1, 2014. Our primary outcomes were the change in all-cause 1-year mortality and leg amputation. We used a state-level difference-in-differences (DID) analysis to compare the rates of the primary outcomes among patients who were in states (including the District of Columbia) who adopted ME ( n = 25) versus those who were in states that did not ( n = 26). We performed a subanalysis stratifying by sex, race, region, and dual-eligibility status. Results: Over the 8-year period, we studied 37,743,929 patients. The average unadjusted 1-year mortality decreased from 2011 to 2018 in both non-ME (9.5% to 8.7%, p &lt; 0.001) and ME (9.1% to 8.3%, p &lt; 0.001) states. The average unadjusted 1-year amputation rate did not improve in either the non-ME (0.86% to 0.87%, p = 0.17) or ME (0.69% to 0.69%, p = 0.65) states. Across the entire cohort, the DID model revealed that ME did not lead to a significant change in mortality ( p = 0.15) or amputation ( p = 0.34). Conclusion: Medicaid Expansion was not associated with reduced mortality or leg amputation in Medicare beneficiaries with PAD.<\/jats:p>","DOI":"10.1177\/1358863x241237776","type":"journal-article","created":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T11:12:01Z","timestamp":1712920321000},"page":"398-404","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["The impact of the Affordable Care Act Medicaid Expansion in Medicare beneficiaries with peripheral artery disease"],"prefix":"10.1177","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5968-1216","authenticated-orcid":false,"given":"Stanislav","family":"Henkin","sequence":"first","affiliation":[{"name":"Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA"},{"name":"Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen A","family":"Kearing","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pablo","family":"Martinez-Camblor","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaos","family":"Zacharias","sequence":"additional","affiliation":[{"name":"Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9758-6447","authenticated-orcid":false,"given":"Mark A","family":"Creager","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael N","family":"Young","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip P","family":"Goodney","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA"},{"name":"Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3225-4403","authenticated-orcid":false,"given":"Jesse A","family":"Columbo","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA"},{"name":"Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,4,12]]},"reference":[{"key":"bibr1-1358863X241237776","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001123"},{"key":"bibr2-1358863X241237776","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2006.03.026"},{"key":"bibr3-1358863X241237776","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2014.03.290"},{"key":"bibr4-1358863X241237776","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2012.12.002"},{"key":"bibr5-1358863X241237776","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2013.10.032"},{"key":"bibr6-1358863X241237776","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2006.09.044"},{"key":"bibr7-1358863X241237776","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2008.05.010"},{"key":"bibr8-1358863X241237776","unstructured":"US Department of Health & Human Services (HHS). 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