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. 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.
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 (US). States were
grouped into regions as defined by the US Census Bureau. Medicaid as the primary payor
for bariatric surgery was compared by region and year, as well as utilization by marginalized
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 were located in the Northeast and West, as compared with 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.
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 US states.