Study: Medicaid expansion linked to improved access to care, health outcomes

Respondents in Medicaid-expansion states reported seeing a doctor more often

Low-income U.S. residents living in two Medicaid-expansion states reported better access to care and general health than those living in Texas, which did not expand Medicaid under the Affordable Care Act (ACA), according to a study published Monday in JAMA Internal Medicine.

Thirty-one states and Washington, D.C., have expanded Medicaid under the ACA. Six of those states expanded Medicaid  via alternative expansion plans.

Study details

The study focused on:

  • Arkansas, which implemented an alternative Medicaid expansion plan;
  • Kentucky, which expanded its traditional Medicaid program; and
  • Texas, which has not expanded Medicaid.

The researchers polled residents in all three states in 2013 (before Medicaid expansion took effect), in 2014 (after the law had been in place for one year), and at the end of 2015.

Respondents reported their overall health care, ED, and outpatient care use, as well as their access to annual checkups, blood sugar and cholesterol testing, medications, primary care, and specialty care.

Findings

The study found that compared with Texas, Medicaid expansion in Arkansas and Kentucky was associated with a 22.7 percentage-point reduction in the uninsured rate in 2015.

In addition, the study found that Medicaid beneficiaries in expansion states were visiting physicians more frequently and had an easier time paying for care than those in non-expansion states.

When compared with nonexpansion in Texas, the study found that Medicaid expansion in Arkansas and Kentucky was associated with a:

  • 16.1 percentage-point increase in residents' likelihood to have received a checkup in the last year;
  • 14 percentage-point decrease in difficulty paying medical bills;
  • 12 percentage-point increase in receiving regular care for a chronic condition;
  • 11.6 percentage-point decrease in skipping prescription drugs because of costs;
  • 6.3 percentage-point increase in screening for diabetes; and
  • 6 percentage-point decrease in likelihood of using the ED.

Here's how CMS wants hospitals to reduce readmissions for low-income, minority patients

According to the Los Angeles Times, the increased accessed to care found in the study suggests that individuals living in expansion states may end up having better health outcomes. Arkansas and Kentucky residents were almost five percentage points more likely than Texas residents to report excellent health in 2015, according to the study.

The researchers wrote, "In the second year of expansion, Kentucky's Medicaid program and Arkansas's private option were associated with significant increases in outpatient utilization, preventive care, and improved health care quality; reductions in emergency department use; and improved self-reported health."

Lead study author Benjamin Sommers said, "The effects of expanding coverage will be an unfolding story over time. But we are starting to see the kind of broad-based improvements that we would expect with better access."

The researchers concluded that the findings "sugges[t] that coverage expansion ... can produce substantial benefits for low-income populations" (Doyle, Reuters, 8/8; Sanger-Katz, "The Upshot," New York Times, 8/9; Levey, Los Angeles Times, 8/8; Sullivan, The Hill, 8/8).

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