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Loss of Medicaid insurance after successful bariatric surgery: an unintended outcome

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Abstract

Background

Bariatric surgery leads to dramatic weight loss and improved overall health, which may affect insurance status for certain patients. Traditional Medicaid provides coverage for children, pregnant women, and disabled adults, while expanded Medicaid provides insurance coverage to all adults with incomes up to 138% of the federal poverty level. We hypothesized that successful bariatric surgery would lead to improved health status but an unintended loss of Medicaid coverage.

Methods

All patients who underwent bariatric surgery at a single institution in a non-expansion state from 1985 through 2015 were identified using a prospectively collected database. Univariate and multivariate analyses were used to identify differences in patients who lost Medicaid coverage after bariatric surgery.

Results

Over the 30-year study period, 3487 patients underwent bariatric surgery, with 373 (10.7%) having Medicaid coverage at the time of surgery. This cohort of patients had a median age of 37 years and a preoperative Body Mass Index (BMI) of 54 kg/m2. At one-year follow-up, 155 (41.6%) patients lost Medicaid coverage, of which 76 (49.0%) had no coverage. The preoperative prevalence of diabetes (32.3 vs. 44.0%, p = 0.02), age (36 vs. 38 years, p = 0.01), and BMI (53 vs. 55 kg/m2, p = 0.04) were significantly lower in patients who no longer qualified for Medicaid after bariatric surgery. Multivariate regression demonstrated that for every 10 point increase in BMI (OR 0.755, p = 0.01), a patient was 25% less likely to lose their coverage at one year.

Conclusions

Successful surgery in a state not expanding Medicaid resulted in over 40% of patients losing Medicaid coverage postoperatively, with half of those patients returning for follow-up with no insurance coverage at all. This barrier to care has major implications in patients undergoing bariatric surgery, which requires life-long follow-up and nutrition screening.

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References

  1. Maciejewski ML, Arterburn DE, Van Scoyoc L, Smith VA, Yancy WS Jr, Weidenbacher HJ, Livingston EH, Olsen MK (2016) Bariatric surgery and long-term durability of weight loss. JAMA Surg 151:1046–1055

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mehaffey JH, LaPar DJ, Clement KC, Turrentine FE, Miller MS, Hallowell PT, Schirmer BD (2016) 10-year outcomes after Roux-en-Y gastric bypass. Ann Surg 264:121–126

    Article  PubMed  Google Scholar 

  3. Prospective Studies C, Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, Qizilbash N, Collins R, Peto R (2009) Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 373:1083–1096

    Article  Google Scholar 

  4. Sjostrom L, Peltonen M, Jacobson P, Sjostrom CD, Karason K, Wedel H, Ahlin S, Anveden A, Bengtsson C, Bergmark G, Bouchard C, Carlsson B, Dahlgren S, Karlsson J, Lindroos AK, Lonroth H, Narbro K, Naslund I, Olbers T, Svensson PA, Carlsson LM (2012) Bariatric surgery and long-term cardiovascular events. JAMA 307:56–65

    Article  PubMed  Google Scholar 

  5. Mehaffey JH, Mullen MG, Mehaffey RL, Turrentine FE, Malin SK, Kirby JL, Schirmer B, Hallowell PT (2016) Type 2 diabetes remission following gastric bypass: does diarem stand the test of time? Surg Endosc 31(2):538–542

    Article  PubMed  Google Scholar 

  6. Pories WJ, Mehaffey JH, Staton KM (2011) The surgical treatment of type two diabetes mellitus. Surg Clin N Am 91:821–836

    Article  PubMed  Google Scholar 

  7. Mehaffey JH, LaPar DJ, Turrentine FE, Miller MS, Hallowell PT, Schirmer BD (2015) Outcomes of laparoscopic Roux-en-Y gastric bypass in super-super-obese patients. Surg Obes Relat Dis 11:814–819

    Article  PubMed  Google Scholar 

  8. U.S. Supreme Court. National Federation of Independent Business et al. v. Sebelius, Secretary of Health and Human Services, et al. Available at https://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf. Accessed 15 Aug 2016

  9. The Henry J. Kaiser Family Foundation. A guide to the Supreme Court’s decision on the ACA’s Medicaid expansion. Available at https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8347.pdf. Accessed 13 Aug 2016

  10. The Henry J. Kaiser Family Foundation. Status of state action on the Medicaid expansion decision. Available at http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-theaffordable-care-act/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Accessed 15 Aug 2016

  11. Virginia Department of Social Services Medicaid Fact Sheet #45. Available at https://www.dss.virginia.gov/files/division/bp/medical_assistance/forms/all_other/d032-03-0452-03-eng.pdf. Accessed 14 Dec 2016

  12. Medicaid.com. Centers for Medicare & Medicaid Services. Affordable Care Act eligibility, Medicaid expansion. Available at https://www.medicaid.gov/affordable-care-act/eligibility/index.html. Accessed 13 Aug 2016

  13. Rhoads KF, Ackerson LK, Jha AK, Dudley RA (2008) Quality of colon cancer outcomes in hospitals with a high percentage of Medicaid patients. J Am Coll Surg 207:197–204

    Article  PubMed  Google Scholar 

  14. Yong CM, Abnousi F, Asch SM, Heidenreich PA (2014) Socioeconomic inequalities in quality of care and outcomes among patients with acute coronary syndrome in the modern era of drug eluting stents. J Am Heart Assoc 3:e001029

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lapar DJ, Bhamidipati CM, Walters DM, Stukenborg GJ, Lau CL, Kron IL, Ailawadi G (2011) Primary payer status affects outcomes for cardiac valve operations. J Am Coll Surg 212:759–767

    Article  PubMed  PubMed Central  Google Scholar 

  16. LaPar DJ, Ghanta RK, Kern JA, Crosby IK, Rich JB, Speir AM, Kron IL, Ailawadi G, Investigators for the Virginia Cardiac Surgery Quality I (2014) Hospital variation in mortality from cardiac arrest after cardiac surgery: an opportunity for improvement? Ann Thorac Surg 98:534–539

    Article  PubMed  PubMed Central  Google Scholar 

  17. LaPar DJ, Stukenborg GJ, Guyer RA, Stone ML, Bhamidipati CM, Lau CL, Kron IL, Ailawadi G (2012) Primary payer status is associated with mortality and resource utilization for coronary artery bypass grafting. Circulation 126:S132–S139

    Article  PubMed  PubMed Central  Google Scholar 

  18. Yuan X, Martin Hawver LR, Ojo P, Wolfe LM, Meador JG, Kellum JM, Maher JW (2009) Bariatric surgery in Medicare patients: greater risks but substantial benefits. Surg Obes Relat Dis 5:299–304

    Article  PubMed  Google Scholar 

  19. Hayes S, Napolitano MA, Lent MR, Wood GC, Gerhard GS, Irving BA, Argyropoulos G, Foster GD, Still CD (2015) The effect of insurance status on pre- and post-operative bariatric surgery outcomes. Obes Surg 25:191–194

    Article  PubMed  PubMed Central  Google Scholar 

  20. Dallal RM, Datta T, Braitman LE (2007) Medicare and Medicaid status predicts prolonged length of stay after bariatric surgery. Surg Obes Relat Dis 3:592–596

    Article  PubMed  Google Scholar 

  21. Shah M, Simha V, Garg A (2006) Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab 91:4223–4231

    Article  CAS  PubMed  Google Scholar 

  22. Del Villar Madrigal E, Neme-Yunes Y, Clavellina-Gaytan D, Sanchez HA, Mosti M, Herrera MF (2015) Anemia after Roux-en-Y gastric bypass. How feasible to eliminate the risk by proper supplementation? Obes Surg 25:80–84

    Article  Google Scholar 

  23. Blume CA, Boni CC, Casagrande DS, Rizzolli J, Padoin AV, Mottin CC (2012) Nutritional profile of patients before and after Roux-en-Y gastric bypass: 3-year follow-up. Obes Surg 22:1676–1685

    Article  PubMed  Google Scholar 

  24. Tsai AG, Hosokawa P, Schoen J, Prochazka AV (2014) Frequency of laboratory testing among gastric bypass patients. Surg Obes Relat Dis 10:340–345

    Article  PubMed  Google Scholar 

  25. Varban OA, Hawasli AA, Carlin AM, Genaw JA, English W, Dimick JB, Wood MH, Birkmeyer JD, Birkmeyer NJ, Finks JF (2015) Variation in utilization of acid-reducing medication at 1 year following bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Surg Obes Relat Dis 11:222–228

    Article  PubMed  Google Scholar 

  26. Donadelli SP, Junqueira-Franco MV, de Mattos Donadelli CA, Salgado W Jr, Ceneviva R, Marchini JS, Dos Santos JE, Nonino CB (2012) Daily vitamin supplementation and hypovitaminosis after obesity surgery. Nutrition 28:391–396

    Article  CAS  PubMed  Google Scholar 

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Funding

The National Institutes of Health under Award Number T32HL007849 and UM1HL088925 supported the research reported in this publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA

    J. Hunter Mehaffey, Eric J. Charles, Irving L. Kron, Bruce Schirmer & Peter T. Hallowell

Authors
  1. J. Hunter Mehaffey
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  2. Eric J. Charles
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  3. Irving L. Kron
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  4. Bruce Schirmer
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  5. Peter T. Hallowell
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Corresponding author

Correspondence to Peter T. Hallowell.

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Disclosures

Drs. Mehaffey, Charles, Kron, Schirmer, and Hallowell have no conflicts of interest or financial ties to disclose.

Additional information

Presented at the SAGES 2017 Annual Meeting, March 22-25, 2017, Houston, Texas.

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Mehaffey, J.H., Charles, E.J., Kron, I.L. et al. Loss of Medicaid insurance after successful bariatric surgery: an unintended outcome. Surg Endosc 32, 212–216 (2018). https://doi.org/10.1007/s00464-017-5661-3

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  • DOI: https://doi.org/10.1007/s00464-017-5661-3

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