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Impact of Health Insurance Expansions on Nonelderly Adults With Hypertension

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This figure illustrates the disease state transitions in our Markov chain model. Complete transitions are shown only for individuals with a history of myocardial infarction. Insurance status was assumed to affect an individual’s annual probabilities of CVD and 1-year mortality after a CVD event.

Figure 1. Simplified diagram of the Markov process. Abbreviation: CHD, coronary heart disease; CVD, cardiovascular disease; MI, myocardial infarction.

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Scenario and Race/Ethnicity Age, y
25–34 y 35–44 y 45–54 y 55–64 y
Reduction in No. of CVD Events, %
Expansion scenario 1
White 1.17 0.86 0.45 0.31
Black 2.73 1.46 0.92 0.51
Nonwhite Hispanic 3.24 2.51 1.73 1.07
Expansion scenario 2
White 2.40 2.02 1.05 0.54
Black 5.16 3.08 1.87 0.85
Nonwhite Hispanic 9.36 6.80 4.51 2.82
Reduction in Total Deaths, %
Expansion scenario 1
White 4.39 2.23 1.11 0.83
Black 7.59 3.60 1.70 1.43
Nonwhite Hispanic 7.22 3.80 1.68 0.80
Expansion scenario 2
White 7.19 4.15 2.35 1.27
Black 13.23 7.12 3.70 2.23
Nonwhite Hispanic 19.59 10.31 4.56 2.16

Figure 2. Estimated reduction in cardiovascular events and mortality rates under insurance expansions for white, black, and nonwhite Hispanic populations, by age group. These charts illustrate the racial/ethnic-specific effects of insurance coverage expansion by age group. Outcomes are measured by percentage reduction in cardiovascular events and mortality rates. Scenario 1 assumes currently undecided states opting out of Medicaid expansion, and scenario 2 assumes the entire US population is covered by insurance.

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