Medicaid expansion doesn't hurt healthcare access

Expanding Medicaid eligibility neither reduced care access nor increased emergency department (ED) use, according to a new study published in JAMA Internal Medicine.

Researchers, led by Chima D. Ndumele, Ph.D., from the Yale School of Public Health, New Haven, Conn., and the Brown University School of Public Health, Providence, R.I., analyzed data to test the perception that Medicaid expansion erodes access by increasing demand for services.

"Medicaid enrollees typically report worse access to care than other insured populations. Expansions in Medicaid through less restrictive income eligibility requirements and the resulting influx of new enrollees may further erode access to care for those already enrolled in Medicaid," the authors wrote.

However, upon analyzing self-reported perceptions of care access from previous expansions of the program, researchers found that, in 10 states that expanded Medicaid between 2000 and 2009, enrollee reports of poor care access fell from 8.5 percent to 7.3 percent. In states that did not expand access, reports of poor access remained the steady during the same timeframe. ED use decreased among Medicaid enrollees in both expansion and control states, falling from 41.2 percent to 40.1 percent in expansion states and decreasing from 37.3 percent to 36.1 percent in control states, according to the report.

"We found no evidence that expanding the number of individuals eligible for Medicaid coverage erodes perceived access to care or increases the use of ED services among adult Medicaid enrollees," the authors wrote.

"The gap between health insurance and healthcare can be particularly challenging for many Medicaid recipients to bridge," Mitchell Katz, M.D., director of the Los Angeles County Department of Health Services, wrote in an accompanying commentary. "Studies have shown that a substantial proportion of physicians do not accept new Medicaid patients. Therefore, amid the optimism that millions of previously uninsured persons will gain Medicaid coverage, there is a fear that the newly insured will not be able to find physicians who will care for them, or that the influx of new enrollees will make access harder for those persons who already have Medicaid. In this vein, the results of this are reassuring."

Previous research suggested that Massachusetts' expansion of health insurance increased ED use without reducing hospital readmissions, FierceHealthcare previously reported.

To learn more:
- here's the study abstract
- here's the commentary