Anticipating the effects of Medicaid expansion on surgical care.

Anticipating the Effects ofMedicaid Expansion on Surgical Care TheAffordableCareActexpandedMedicaidcoverage toadults with incomesup to 133%of the federalpoverty level, but a subsequentSupremeCourt rulingdeterminedCongress couldgive states the option to expand. In September of 2013, the state of Michigan approved expansion. Beginning inApril 2014,more than 400 000 adults will be newly eligible for Medicaid enrollment in the state.1 The effect of this influx of patients on surgical care and hospital costs in Michigan is unknown. Previous national studies of Medicaid patients undergoing surgery have shown worse outcomes2 and increased costs.3 Given that the Affordable Care Act also mandates a reduction in payments to disproportionate share hospitals,4 increased Medicaid enrollment could have substantial clinical and financial implications for hospitals facing expansion. To better understand this change, using a statewide clinical registry, we examined the surgical outcomes and resource use of Medicaid patients in Michigan the year prior to implementation of the Affordable Care Act.