A new systematic review finds that the Affordable Care Act, particularly its Medicaid Expansion provision, has significantly improved access to care, survival, and racial equity for patients with chronic liver disease. The review, published in Clinical Gastroenterology and Hepatology, analyzed 27 studies spanning hepatitis C, liver transplantation, hepatocellular carcinoma, and cirrhosis.
Of those studies, 23 reported better outcomes in states that expanded Medicaid compared to those that did not. Liver transplant listings rose by up to 6% in expansion states. Early-stage liver cancer diagnoses increased by 5.4%, and cirrhosis-related deaths rose more slowly—by as much as 10 fewer deaths per 100,000—where Medicaid was expanded.
The review also highlighted the ACA’s role in reducing racial and ethnic disparities. Improved access to early diagnosis and treatment translated into better survival rates for Medicaid-eligible adults, particularly in communities historically underserved by the healthcare system.
Researchers emphasized that most studies reviewed were methodologically strong, using causal inference techniques and showing low to moderate risk of bias. The findings suggest that patients in non-expansion states could benefit from similar policies.
As liver disease continues to rise in the U.S., the review calls for future health policy to build on the ACA’s successes. Expanding Medicaid in remaining states, the authors argue, could be a critical step toward closing persistent gaps in liver health outcomes.
See “The Affordable Care Act Improves Access, Survival, and Racial Disparities of Patients with Liver Disease: A Systematic Review” (July 7, 2025)
