Medicaid expansion boosts access, reduces costs for poor

Researchers say states that participated under Affordable Care Act also saw longer wait times for low-income residents

States that participated in Medicaid expansion under the Affordable Care Act, or ACA, saw increased numbers of insured, better access to care and less worry about paying medical bills, but also longer wait times among low-income residents, according to new research.

In a study published this month in the New England Journal of Medicine, Laura Wherry, assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, and Sarah Miller, assistant professor of business economics and public policy at the University of Michigan, analyzed survey data from states that participated in the Medicaid expansion and states that declined.

Under the Affordable Care Act, Medicaid eligibility was expanded to individuals earning up to 138 percent of the federal poverty level. Though the expansion was initially intended to apply to all states, a U.S. Supreme Court ruling left the decision as to whether to expand up to the states. As of January 1, 2017, 31 states and the District of Columbia have adopted the Medicaid expansion, according to the Kaiser Family Foundation.

The researchers found that the numbers of uninsured dropped in the expansion states in year two after implementation by 8.2 percentage points and Medicaid coverage increased 15.6 percentage points among low-income residents when compared with non-expansion states.

Though expansion wasn’t associated with significant changes in health status, expansion states saw an increase in the ability of low-income residents to afford follow-up care — 3.4 percentage points compared with non-expansion states — and fewer reports of concerns about paying medical bills — a decrease of 7.9 percentage points compared with non-expansion states.

“Medicaid expansion appears to help low-income adults afford the medical care they need,” Wherry said.

The study comes as Congress debates a proposed replacement of the Affordable Care Act.

“These results suggest that any proposed cuts to the ACA Medicaid expansions would substantially reduce access to health care for low-income individuals,” Miller said.

Wherry and Miller also found that expansion states reported increases in medical care delays caused by wait times for appointments for low-income residents — a 2.6-percentage-point increase over non-expansion states.

The researchers compared changes in outcomes two years after the Medicaid expansion — 2014 and 2015 — relative to the four years before it. They used data from the National Health Interview Survey and compared results from expansion and non-expansion states. The survey sample was 60,766 U.S. citizens from 19 to 64 years of age who had incomes below 138 percent of the federal poverty level.

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