Study: Medicaid expansion linked to better care access, better health for low-income populations

By several different measures, low-income individuals in two states that expanded Medicaid under the Affordable Care Act were better off than those in a state that didn’t expand eligibility, according to new research.

The study, published this week in the journal Health Affairs, examined changes in self-reported health and healthcare use for individuals in Kentucky, Arkansas and Texas.

Kentucky expanded Medicaid under the ACA, while Texas did not. Arkansas, on the other hand, secured a waiver that allowed it to use federal Medicaid funds to purchase private insurance for low-income individuals on the federal marketplace.

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As of the end of 2016, or three years into Medicaid expansion, Kentucky’s uninsured rate had dropped to 7.4%, and Arkansas’ was down to 11.7%. Between 2013 and 2014, both states also led the nation in reducing their uninsured rates, per a previous poll. In Texas, on the other hand, the uninsured rate was 28.2% at the end of 2016.

Among low-income adults who gained coverage in Kentucky and Arkansas, there were other benefits: they experienced a $337 reduction in annual out-of-pocket costs; 41% increase in having a usual source of care, 23% increase in “excellent” self-reported health; and significant increases in preventive health visits and glucose testing.

For those with chronic conditions—individuals who account for a large share of healthcare spending—there were improvements in regularity and affordability of care, medication adherence and self-reported health.

Because Kentucky and Arkansas took different approaches to Medicaid expansion and still experienced similar benefits, the study notes that this could have implications for alternative state approaches to expanding coverage, a concept the Trump administration has encouraged. Those results, it says, “imply that coverage expansion is quite important for patients, but the type of coverage obtained is less critical.”

The three-state study echoes another recent study, also published in Health Affairs, which found that as of 2015, states that expanded Medicaid saw greater declines in uninsured rates for low-income adults compared to states that declined to expand eligibility.