Effect of Medicaid Expansion on Access to Pelvic Organ Prolapse Surgery

IMPORTANCE: Medicaid expansion increased access to care; however, there are limited data about its effect on access to pelvic organ prolapse (POP) repair. OBJECTIVE: We aimed to determine the effect of Medicaid expansion on POP surgery by region, socioeconomic status, and race. STUDY DESIGN: This was a retrospective cohort study utilizing the 2012-2019 Healthcare Cost and Utilization Project National Inpatient Sample. Medicaid-funded POP repair surgical procedures were compared over time by region and among marginalized populations. RESULTS: During the study period, 175,355 POP surgical procedures were performed. The proportion of Medicaid-funded POP surgery was highest in the West (16%) and Northeast (10%) and lowest in the Midwest (6%) and South (5%), corresponding to the regions with the highest and lowest rates of Medicaid expansion; this was significant (P<0.001) even after controlling for confounders. The proportion of Medicaid-funded POP surgery for Black, Hispanic, and lowest-income quartile patients decreased or remained the same during the study period in the South, the region with the least Medicaid expansion. CONCLUSION: The regions with higher rates of Medicaid expansion were found to have higher rates of publicly insured and marginalized patients undergoing POP repair.