- A new Government Accountability Office study adds to a growing body of evidence that Medicaid expansion improves access to care, finding that low-income adults in expansion states were less likely to have unmet medical needs compared both with low-income adults in non-expansion states and low-income adults who were uninsured.
- Low-income adults in expansion states were also less likely to report financial barriers to needed medical care, including specialty care, and more likely to report having a regular place of care, than those in non-expansion states and those who were uninsured. On each of the access questions, uninsured in expansion states fared better than uninsured in non-expansion states, according to the report released Monday.
- Also Monday, CMS named expansion critic and former Maine Health and Human Services Commissioner Mary Mayhew as the new director of Medicaid and the Children's Health Insurance Program. Mayhew has urged states not to expand their Medicaid programs and has also spoken in favor of policies like work requirements.
According to National Health Interview Survey estimates, 5.6 million low-income adults were uninsured in 2016 — 1.9 million in Medicaid expansion states and 3.7 million in non-expansion states. Of those, more than half were male, employed and had incomes below 100% of the federal poverty level.
In expansion states, half of low-income adults reported having unmet medical needs, versus 63% in non-expansion states. The share reporting they could not afford needed medical care was 9% in expansion states versus 20% for non-expansion states.
"Estimates from the 2016 NHIS showed some statistically significant differences in the health status of uninsured, low-income adults in expansion and non-expansion states. In particular, expansion states had a larger percentage of these adults who reported that their health was 'good' and a smaller percentage who reported their health as 'fair or poor' than those in non-expansion states," according to the report. "However, the percentages of uninsured, low-income adults with responses of 'excellent or very good' in both expansion and non-expansion states were large — 47 percent or larger, and the differences between the two groups of states were not statistically different."
Evidence that Medicaid expansion benefits health is mounting. In a recent JAMA Network study, hospitals in expansion states saw fewer uninsured patients for major cardiovascular events within one year of implementation, compared with non-expansion states. The study of 3 million non-Medicare hospitalizations across 30 states also showed a 5.8% decrease for uninsured hospitalizations after Medicaid expansion, compared with non-expansion states.
Another study by Georgetown University's Health Policy Institute and the University of North Carolina's NC Rural Health Project revealed a 19% drop in the uninsured rate for people living at 138% of the federal poverty level — from 35% to 16% — in small towns and rural areas in states with expanded Medicaid. And a Health Affairs analysis found more use of primary care, mental health and preventive care visits among Medicaid enrollees in expansion states.
Not only does expanding the health insurance tent to more low-income people improve overall health, it also ensures more reliable funding for hospitals and less charity care.
Medicaid expansion was a major part of more people getting insured under the Affordable Care Act. Currently, 33 states and the District of Columbia have expanded the program, which allows for people at up to 400% of the federal poverty level.
Maine and Virginia are expected to expand their programs next year. Virginia lawmakers approved a measure to add 400,000 beneficiaries to its Medicaid rolls in May. Maine voters approved a ballot referendum to expand Medicaid in 2016, but its Republican governor, Paul LePage, has fought to block the program. However, with his term ending in January, Maine's expansion could get underway.
Four states will vote on Medicaid expansion ballot initiatives Nov. 6. Analysts predict voters in Idaho, Nebraska and Utah will approve expansion efforts, while a question on whether to maintain Montana's expansion is expected to fail.