Medicaid Expansion: the impact of health policy on bariatric surgery.

BACKGROUND: Underutilization of bariatric surgery in uninsured and marginalized communities is well-documented. When discussing population health, healthcare access and equity are crucial components often influenced by health policy. OBJECTIVES: This study aims to determine if disparities in the use of bariatric surgery were influenced by changes in healthcare policy from the Affordable Care Act's 2014 expansion of Medicaid. SETTING: A retrospective analysis of the 2012-2018 Healthcare Cost and Utilization Project National Inpatient Sample was performed for elective Roux-en-Y gastric bypass and sleeve gastrectomy surgeries performed within the United States. METHODS: States were grouped into regions as defined by the U.S. Census Bureau. Medicaid as the primary payor for bariatric surgery was compared by region and year, as well as utilization by marginalized populations. RESULTS: Analysis included 212,776 bariatric surgeries. Medicaid as the primary payor increased from 9% to 19% from 2012 to 2018. A greater share of bariatric surgeries with Medicaid as the primary payor was located in the Northeast and West, as compared with those located in the Midwest and South. Medicaid beneficiaries in marginalized communities (Black race, Hispanic race, lowest income quartile, rural communities) made up a larger share of the bariatric surgery population over time. CONCLUSIONS: The Affordable Care Act's Medicaid Expansion improved health coverage and access to care, including bariatric surgery. An increase in bariatric surgeries among Medicaid beneficiaries correlated with the 2014 expansion of Medicaid. Social and economic disparities regarding bariatric surgery have improved though more progress may be seen with the adoption of Medicaid Expansion by the remaining U.S. states.