Medicaid expansion improved care access and coverage, analysis finds
Medicaid expansion led to increases in coverage and Medicaid spending and improved access to care and quality of care for residents, according to a new Health Affairs report.
The analysis of more than 70 studies on the subject found more use of primary care, mental health and preventive visits among Medicaid enrollees. There were decreased hospital lengths-of-stay among newly insured beneficiaries as well.
However, there were conflicting results for hospitalization rates. Several studies found decreased hospitalizations, including admissions that were potentially preventable among uninsured people, while others said there were increased hospitalizations and emergency department (ED) visits among Medicaid enrollees.
Medicaid expansion is credited with getting more than 14 million people on health insurance after the Affordable Care Act passed. The ACA allowed states to expand Medicaid eligibility to 138% of the federal poverty level, and so far 34 states and the District of Columbia have opted to do so.
Despite those coverage gains, Medicaid expansion is still considered a controversial issue in many states. Virginia will likely become the next state to expand Medicaid after the legislature approved the plan last week. There are still more than a dozen states that haven’t grown the federal/state health insurance program, but ballot questions may let votes decide the issue in multiple states this fall.
While supporters in some states hope to expand Medicaid, others that already expanded the program are looking for ways to make cuts. Kentucky became the first state to get a work requirement waiver that will require non-disabled Medicaid recipients to work. Three other states have since received similar waivers.
Meanwhile, researchers have released dozens of studies focused on how Medicaid expansion has impacted healthcare. The Health Affairs report dug into 77 studies that contained 440 unique analyses. A total of 61% of the analyses reported a “significant effect of Medicaid expansion consistent with the goals of the ACA,” 35% reported no significant effect and 4% reported a result inconsistent with the ACA goals.
The report found that three-fourths of the analyses saw insurance coverage improvements following Medicaid expansion. Adults without a college degree saw the largest coverage gains. Medicaid expansion also led to a drop in short-term and long-term uninsured rates.
The study authors found that 40% of the analyses related to appointment availability or wait times found improvements after Medicaid expansion. There was also a decrease in the share of adults reporting access to care problems in the Medicaid expansion states. Plus, Medicaid expansion led to decreased reliance on EDs as a usual source of care.
The study also found improved glucose monitoring rates for patients with diabetes, better hypertension control and higher rates of prostate cancer screening and Pap tests. “No study reported a decrease in health or quality of care following Medicaid expansion,” the authors wrote.
Concerning the cost of care, the study authors found three-fourths of the analyses on that topic discovered Medicaid expenditure increases, as well as improved hospital financial performance. That includes reducing uncompensated care, better excess margins and Medicaid revenues. However, two related analyses from the same study reported an increase in nonprofit hospitals’ bad debts and a decrease in charity care expenses for for-profit hospitals.
Overall, the study authors said Medicaid expansion has benefited healthcare, though they acknowledged that there is limited evidence about whether Medicaid expansion “had a significant effect on health status.” They concluded: “While the literature is still incomplete, current studies paint a picture of significantly more improvements in various outcomes than negative effects with respect to the main goals of the ACA.”