Skip to main content

Main menu

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • JASN Podcasts
    • Article Collections
    • Archives
    • Kidney Week Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
  • Editorial Team
  • Editorial Fellowship
    • Editorial Fellowship Team
    • Editorial Fellowship Application Process
  • More
    • About JASN
    • Advertising
    • Alerts
    • Feedback
    • Impact Factor
    • Reprints
    • Subscriptions
  • ASN Kidney News
  • Other
    • ASN Publications
    • CJASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology

User menu

  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
American Society of Nephrology
  • Other
    • ASN Publications
    • CJASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Advertisement
American Society of Nephrology

Advanced Search

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • JASN Podcasts
    • Article Collections
    • Archives
    • Kidney Week Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
  • Editorial Team
  • Editorial Fellowship
    • Editorial Fellowship Team
    • Editorial Fellowship Application Process
  • More
    • About JASN
    • Advertising
    • Alerts
    • Feedback
    • Impact Factor
    • Reprints
    • Subscriptions
  • ASN Kidney News
  • Follow JASN on Twitter
  • Visit ASN on Facebook
  • Follow JASN on RSS
  • Community Forum
Clinical Epidemiology
You have accessRestricted Access

Medicaid Expansion and Incidence of Kidney Failure among Nonelderly Adults

Rebecca Thorsness, Shailender Swaminathan, Yoojin Lee, Benjamin D. Sommers, Rajnish Mehrotra, Kevin H. Nguyen, Daeho Kim, Maricruz Rivera-Hernandez and Amal N. Trivedi
JASN June 2021, 32 (6) 1425-1435; DOI: https://doi.org/10.1681/ASN.2020101511
Rebecca Thorsness
1Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Rebecca Thorsness
Shailender Swaminathan
1Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
2Providence Veterans Affairs Medical Center, Providence, Rhode Island
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Yoojin Lee
1Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Benjamin D. Sommers
3Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
4Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Rajnish Mehrotra
5Division of Nephrology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Rajnish Mehrotra
Kevin H. Nguyen
1Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Daeho Kim
1Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Maricruz Rivera-Hernandez
1Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Amal N. Trivedi
1Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
2Providence Veterans Affairs Medical Center, Providence, Rhode Island
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data Supps
  • Info & Metrics
  • View PDF
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Visual Abstract

Figure
  • Download figure
  • Open in new tab
  • Download powerpoint

Significance Statement

Prior work suggests that uniform access to health insurance coverage and health care services reduces disparities in treatment and outcomes of patients with CKD. This study assessed whether expansions of Medicaid coverage to low-income adults in the United States under the Affordable Care Act (ACA) were associated with changes in the incidence rate of kidney failure. The authors found that, in the entire adult population aged 19–64 years, the ACA’s Medicaid expansions were associated with a statistically significant 3% relative reduction in kidney failure incidence in the early period (years 2 and 3) after expansion. However, this decline was not sustained in the later period (years 4 and 5) after expansion. Further research is needed to understand the relationship between expanding health insurance coverage and the incidence of kidney failure.

Abstract

Background Low-income individuals without health insurance have limited access to health care. Medicaid expansions may reduce kidney failure incidence by improving access to chronic disease care.

Methods Using a difference-in-differences analysis, we examined the association between Medicaid expansion status under the Affordable Care Act (ACA) and the kidney failure incidence rate among all nonelderly adults, aged 19–64 years, in the United States, from 2012 through 2018. We compared changes in kidney failure incidence in states that implemented Medicaid expansions with concurrent changes in nonexpansion states during pre-expansion, early postexpansion (years 2 and 3 postexpansion), and later postexpansion (years 4 and 5 postexpansion).

Results The unadjusted kidney failure incidence rate increased in the early years of the study period in both expansion and nonexpansion states before stabilizing. After adjustment for population sociodemographic characteristics, Medicaid expansion status was associated with 2.20 fewer incident cases of kidney failure per million adults per quarter in the early postexpansion period (95% CI, −3.89 to −0.51) compared with nonexpansion status, a 3.07% relative reduction (95% CI, −5.43% to −0.72%). In the later postexpansion period, Medicaid expansion status was not associated with a statistically significant change in kidney failure incidence (−0.56 cases per million per quarter; 95% CI, −2.71 to 1.58) compared with nonexpansion status and the pre-expansion time period.

Conclusions The ACA Medicaid expansion was associated with an initial reduction in kidney failure incidence among the entire, nonelderly, adult population in the United States; but the changes did not persist in the later postexpansion period. Further study is needed to determine the long-term association between Medicaid expansion and changes in kidney failure incidence.

  • chronic kidney disease
  • kidney failure
  • health insurance
  • Medicaid
  • uninsured
  • epidemiology and outcomes
  • Copyright © 2021 by the American Society of Nephrology
View Full Text

If you are:

  • an ASN member, select the "ASN Member" login button. 
  • an individual subscriber, login with you User Name and Password.
  • an Institutional user, select the Institution option where you will be presented with a list of Shibboleth federations. If you do not see your federation, contact publications@asn-online.org. 

ASN MEMBER LOGIN

ASN MEMBER LOGIN

Log in using your username and password

Forgot your user name or password?

Log in through your institution

You may be able to gain access using your login credentials for your institution. Contact your library if you do not have a username and password.

Purchase access

Pay Per Article - You may access this article (from the computer you are currently using) for 1 day for US$34.00

In order to get access to the article, you must have an account.  If you have an account, enter your user name and password into the boxes above. If you do not have an account, follow the instructions below to create one.  Once you have purchased the article, you will have access to it for 24 hours.  

Steps for Creating an Account:

Click the "Purchase Access" button.  The page will redisplay with the following message at the top of the screen. In the message, click to create an account. 

When you create the account, you will be asked to register a user name, email address and you will need to create a password that is at least eight characters in length.  You do not need an ASN Member number to complete the form. As you move through the registration page, you will have to verify you are a person by completing a Captcha request.   Lastly, your first and last name will be required. 

Once your information is successfully saved, the system will redisplay the home page of the journal.  From there, navigate back to the article to purchase.  Select the article and at the bottom of the page, use the credentials you just created to login. The article will be added to your shopping cart.  You can continue to navigate across JASN and CJASN adding to your cart from both journals. When you are ready to complete your purchse, select the Shopping Cart from the upper right hand corner of the page and follow the onscreen instructions. 

PreviousNext
Back to top

In this issue

Journal of the American Society of Nephrology: 32 (6)
Journal of the American Society of Nephrology
Vol. 32, Issue 6
June 2021
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by author
View Selected Citations (0)
Print
Download PDF
Sign up for Alerts
Email Article
Thank you for your help in sharing the high-quality science in JASN.
Enter multiple addresses on separate lines or separate them with commas.
Medicaid Expansion and Incidence of Kidney Failure among Nonelderly Adults
(Your Name) has sent you a message from American Society of Nephrology
(Your Name) thought you would like to see the American Society of Nephrology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Medicaid Expansion and Incidence of Kidney Failure among Nonelderly Adults
Rebecca Thorsness, Shailender Swaminathan, Yoojin Lee, Benjamin D. Sommers, Rajnish Mehrotra, Kevin H. Nguyen, Daeho Kim, Maricruz Rivera-Hernandez, Amal N. Trivedi
JASN Jun 2021, 32 (6) 1425-1435; DOI: 10.1681/ASN.2020101511

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Request Permissions
Share
Medicaid Expansion and Incidence of Kidney Failure among Nonelderly Adults
Rebecca Thorsness, Shailender Swaminathan, Yoojin Lee, Benjamin D. Sommers, Rajnish Mehrotra, Kevin H. Nguyen, Daeho Kim, Maricruz Rivera-Hernandez, Amal N. Trivedi
JASN Jun 2021, 32 (6) 1425-1435; DOI: 10.1681/ASN.2020101511
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Visual Abstract
    • Abstract
    • Methods
    • Results
    • Discussion
    • Disclosures
    • Funding
    • Acknowledgments
    • Supplemental Material
    • Footnotes
    • References
  • Figures & Data Supps
  • Info & Metrics
  • View PDF

More in this TOC Section

  • The Association of Excess Body Weight with Risk of ESKD Is Mediated Through Insulin Resistance, Hypertension, and Hyperuricemia
  • Association of Clonal Hematopoiesis of Indeterminate Potential with Worse Kidney Function and Anemia in Two Cohorts of Patients with Advanced Chronic Kidney Disease
  • Longitudinal TNFR1 and TNFR2 and Kidney Outcomes: Results from AASK and VA NEPHRON-D
Show more Clinical Epidemiology

Cited By...

  • No citing articles found.
  • Google Scholar

Similar Articles

Related Articles

  • PubMed
  • Google Scholar

Keywords

  • chronic kidney disease
  • kidney failure
  • health insurance
  • Medicaid
  • uninsured
  • Epidemiology and outcomes

Articles

  • Current Issue
  • Early Access
  • Subject Collections
  • Article Archive
  • ASN Annual Meeting Abstracts

Information for Authors

  • Submit a Manuscript
  • Author Resources
  • Editorial Fellowship Program
  • ASN Journal Policies
  • Reuse/Reprint Policy

About

  • JASN
  • ASN
  • ASN Journals
  • ASN Kidney News

Journal Information

  • About JASN
  • JASN Email Alerts
  • JASN Key Impact Information
  • JASN Podcasts
  • JASN RSS Feeds
  • Editorial Board

More Information

  • Advertise
  • ASN Podcasts
  • ASN Publications
  • Become an ASN Member
  • Feedback
  • Follow on Twitter
  • Password/Email Address Changes
  • Subscribe to ASN Journals

© 2022 American Society of Nephrology

Print ISSN - 1046-6673 Online ISSN - 1533-3450

Powered by HighWire