The Effect of Insurance Type on Patient Access to Knee Arthroplasty and Revision under the Affordable Care Act

This study evaluated access to knee arthroplasty and revision in 8 geographically representative states. Patients with Medicaid were significantly less likely to receive an appointment compared to patients with Medicare or BlueCross. However, patients with Medicaid had increased success at making an appointment in states with expanded Medicaid eligibility (37.7% vs 22.8%, P = 0.011 for replacement, 42.6% vs 26.9%, P = 0.091 for revision), although they experienced longer waiting periods (31.5 days vs 21.1 days, P = 0.054 for replacement, 45.5 days vs 22.5 days, P = 0.06 for revision). Higher Medicaid reimbursement also had a direct correlation with appointment success rate for Medicaid patients (OR = 1.232, P = 0.001 for replacement, OR = 1.314, P = 0.014 for revision).