Did Medicaid Expansion Help with Bariatric Surgery?

A decade ago, Medicaid expansion was supposed to be a real winner for better access to care. It was a sweet deal for states adopting it. Yet our polarized politics have meant that even now, after a decade, some states are still dragging their feet. That leaves two million people from 12 states in limbo for access to medical care. But let’s drill down to the effect on access to care for severe obesity. Did Medicaid expansion help with access to bariatric surgery?

It turns out that the answer is yes and no.

A Study of 637,557 Bariatric Surgeries

Amresh Hanchate and colleagues analyzed more than 600 thousand bariatric surgeries from 17 states. For this cohort study, they used a difference in differences analysis to overcome some of the limitations of observational research. Their data spanned from 2010 to 2017 in 11 states that expanded Medicaid and six that did not.

What they found was that access to care with bariatric surgery improved for non-Hispanic white people. It was a rather impressive increase of 32 percent. But for Black and Hispanic people, the researchers could detect no improvement. None. Could it be that subtle, systemic bias is at work here? Senior author Kristina Lewis offers perspective:

“This study is a great illustration of what is needed to really achieve health equity – giving everyone access to the same thing (Medicaid in this case) still leaves minority groups further behind. We need to do more for those who are already being left behind.”

Work to Do on Equitable Access to Obesity Care

Let’s be clear. Medicaid expansion has been very good for the health of people who have long had poor access to care. A systematic review in Health Affairs tells us that coverage, service use, and quality of care all improved. Other research suggests outcomes for hypertension and diabetes have improved.

But much work remains undone on ensuring equitable access to obesity care. Obesity doesn’t care if a person is Black or White, male or female. It will chip away at a person’s health, quality of life, and lifespan regardless.

So we cannot cannot continue to tolerate disparities in access to obesity care. Everyone deserves an equal shot at good health and a good, productive life.

Click here for the study by Hanchate et al and here for more on systemic racism in obesity care.

Palace of Justice, Tangier; painting by Henry Ossawa Tanner / WikiArt

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October 16, 2021

One Response to “Did Medicaid Expansion Help with Bariatric Surgery?”

  1. October 16, 2021 at 9:31 am, John DiTraglia said:

    Even in countries with universal health insurance coverage poor people get less. Insurance doesn’t fix everything.