Impact of the Affordable Care Act Medicaid Expansion on Reimbursement in Emergency General Surgery

Vashisht V. Madabhushi, Robert Marlo F. Bautista, Daniel L. Davenport, B. Mark Evers, Joshua M. Judge, Avinash S. Bhakta

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Kentucky had one of the nation’s largest increases in insurance coverage with the Affordable Care Act’s (ACA) Medicaid expansion, quadrupling the proportion of Kentuckians with insurance coverage. This study compares reimbursement rates for surgical procedures performed by emergency general surgery (EGS) services at the University of Kentucky (UK) before and after Medicaid expansion in January 2014. Methods: This IRB-approved, single-institution study retrospectively evaluated all patients undergoing surgical treatment by our EGS team from 1/1/2011 to 12/31/2016. We queried operative records for the most frequently performed procedures by the EGS service. We reviewed patient electronic medical records and hospital financial records to identify insurance status, diagnosis codes, and expected hospital reimbursements, based on UK Hospital’s procedure/payer accounting models. Results: Four thousand six hundred ninety-three patient procedures met inclusion criteria; 46.5% of these came before ACA expansion and 53.5% after expansion. The most frequent procedures performed were incision and drainage, laparoscopic appendectomy, laparoscopic cholecystectomy, and exploratory laparotomy. After ACA expansion, the proportion of patients with Medicaid nearly doubled (19.8% vs. 35.6%, p < 0.001). Concomitantly, there was a more than fivefold decrease in the uninsured patient population after expansion (23.3% vs. 4.6%, p < 0.001), and mean hospital reimbursement increased for laparoscopic appendectomy (13.7%, p < 0.001), laparoscopic cholecystectomy (50.7%, p < 0.001), and incision and drainage (70.2%, p < 0.001). Conclusion: After ACA expansion, there was a sustained decrease in proportion of uninsured patients and a concomitant sustained increase in proportion of patients with access to Medicaid services in the EGS operative population, leading to increased mean hospital reimbursements and decreased patient financial burden.

Original languageEnglish
Pages (from-to)191-196
Number of pages6
JournalJournal of Gastrointestinal Surgery
Issue number1
StatePublished - Jan 2022

Bibliographical note

Funding Information:
Dr. Bautista was supported by a National Institutes of Health (NIH), National Cancer Institute training grant (T32 CA160003): Oncology Research Training for Surgeon-Scientists. Dr. Madabhushi was supported by the University of Kentucky, Center for Clinical and Translational Science, TL1 Grant (NIH: TL1TR001997).

Publisher Copyright:
© 2021, The Society for Surgery of the Alimentary Tract.


  • Affordable Care Act
  • Emergency general surgery
  • Medicaid expansion
  • Reimbursement

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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