Medicaid expansion doesn't impede care access or cause longer wait times, study finds
Expanding Medicaid hasn't impaired access to care or changed healthcare utilization for Medicare patients despite giving millions more people health insurance, according to a new National Bureau of Economic Research (NBER) working paper.
The NBER paper found no change associated with Medicaid expansion concerning office visits, number of days between visits, expenditures and wait times.
The paper's authors said their findings suggest that the 16 non-expansion states could expand the program without causing care access problems.
The Affordable Care Act allowed states to offer Medicaid to people up to 138% of the federal poverty level. About 15 million people have insurance through Medicaid expansion. However, more than a dozen states haven't expanded their programs despite the federal government agreeing to pick up a large portion of the cost.
One common argument against Medicaid expansion is that healthcare systems can't handle an influx of newly insured people. Critics argue that expanding the program will make provider shortages worse and could lead to longer wait times.
The NBER paper explored whether those concerns are warranted. The paper compared use for expansion states and non-expansion states, as well as analyzed different patient groups, including dual-eligibles, which may have more healthcare needs.
The researchers didn't find any "negative spillovers" for Medicare beneficiaries after Medicaid expansion. A different study published last year in the American Economic Journal found a one percentage point increase in the share of working-age adults eligible for Medicaid "has modest effects on the average Medicare beneficiary's spending."
However, NBER's paper found that concerns about expansion hurting an already stretched healthcare system aren't accurate.
Medicaid expansion remains a controversial issue, but a variety of research has shown the benefits. A Government Accountability Office study this week found that low-income adults in Medicaid expansion states have better access to care and a lesser chance of having unmet medical needs compared to those in non-expansion states.
A recent JAMA Network study found that hospitals in expansion states saw fewer uninsured patients for major cardiovascular events within one year of implementation compared with non-expansion states. That study also found a nearly 6% decrease of uninsured hospitalizations after expansion compared to non-expansion states.
However, critics charge that expanding Medicaid is a state budget buster and can cause more healthcare headaches for others in the healthcare system.
As one way to bend the Medicaid cost curve, some expansion states such as Arkansas and New Hampshire have created work requirements for people to get Medicaid coverage. CMS has granted those waivers, but a federal judge in Kentucky later blocked the policy there. CMS reopened the comment period for the proposal.
Though 16 states haven't expanded Medicaid, a handful may soon. Voters in Utah, Nebraska and Idaho will vote on Medicaid expansion ballot questions next month.
There are two others that will come online soon. Virginia will expand its program on Jan. 1 and add 400,000 beneficiaries. Maine voters approved an initiative in 2016, but Republican Gov. Paul LePage has refused to expand the program unless the state legislature finds money for the expansion without raising taxes or tapping into reserves. LePage's term ends in January. Maine officials expect the state will expand Medicaid then.
- National Bureau of Economic Research The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare