Insurance Coverage and Heart Transplant Outcomes

Heart transplantation in the United States has largely been restricted to patients with adequate health insurance coverage to optimize recipient outcomes, particularly in the context of the scarcity of donor organs.1,2 Public health insurance programs, such as Medicaid and Medicare, have been instrumental in providing access to heart transplantation and other solid organ transplants for patients unable to afford private insurance. Recent healthcare reform with implementation of the Affordable Care Act expands the Medicaid program and provides substantial subsidies for low-income patients unable to afford private insurance.3 Oliveira et al4 recently assessed the number of transplant listings in states that have been adopters of the Affordable Care Act and demonstrated that the number of Medicaid beneficiaries listed for heart transplantation increased in states that had adopted the Affordable Care Act to expand Medicaid access compared with states that did not adopt the Affordable Care Act.4 While not assessing the number of heart transplants performed or outcomes after heart transplant, data from the study by Oliveira et al4 reinforce the importance of public health insurance coverage in providing access to heart transplantation services for vulnerable populations.Article, see p 576 Although efforts to improve access to heart transplantation for the uninsured or underinsured are critical and have significant overall benefit for vulnerable populations, access to public health insurance alone has not necessarily translated to equivalent outcomes when heart transplant outcomes for patients with public health insurance are compared with patients with private health insurance coverage.5–8 Previous studies in heart transplantation have demonstrated higher mortality, decreased graft survival, and higher rates of rejection for recipients receiving heart transplants with Medicare or Medicaid health insurance coverage compared with those with private health insurance.5–8 This finding is not unique to heart …