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Background: The Affordable Care Act of 2010 extended health insurance through expansion of Medicaid and subsidies for commercial insurance. Prior work has produced differing results in associating expanded insurance with improvements in health care processes and outcomes. Evaluating specific mechanisms of care processes and their association with insurance expansion may help reconcile those results., Methods and Results: We used inpatient hospitalization data in the Nationwide Inpatient Sample (NIS) Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality from 1/1/2008 to 9/30/2015. We included all hospitalizations for acute myocardial infarction (AMI). As a primary outcome, we defined percent rate of AMI hospitalizations receiving percutaneous coronary intervention (PCI) per month. In the non-Medicare (intervention) group, there was a relative decrease of 0.2% of the monthly trend before and after expansion (95% CI [-0.3%, -0.1%]). In the Medicare group, there was a relative decrease of 0.1% of the monthly trend before and after expansion (95% CI [-0.2%, 0%])., Conclusions: We did not detect a relative difference in PCI for AMI associated with insurance expansion under health reform., Competing Interests: Declaration of competing interest Dr. Haimovich and Ms. Cui have nothing to disclose. Dr. Yeh reports grants and personal fees from Abbott Vascular, grants and personal fees from AstraZeneca, grants and personal fees from Boston Scientific, grants and personal fees from Medtronic, personal fees from Elixir Medical, personal fees from Shockwave Medical, outside the submitted work. Dr. Wasfy reports consulting fees from Pfizer. Dr. Ferris is the national director of transformation of the National Health Service and has served as the CEO of the Massachusetts General Physicians Organization and has served on the board of Health Catalyst., (Copyright © 2021 Elsevier Inc. All rights reserved.)