Obamacare's Medicaid Expansions May Be Improving Care

Study provides early evidence that coverage gains improve use, affordability and quality of care

Monday, August 8, 2016

MONDAY, Aug. 8, 2016 (HealthDay News) -- Low-income adults in Arkansas and Kentucky experienced significant improvements in care after their states expanded Medicaid under the Affordable Care Act, a new study reveals.

The gains were not immediate. But after the second year of coverage, patients had better access to primary care, lower out-of-pocket spending and less reliance on hospital emergency departments for care, compared with low-income adults in Texas. Texas didn't expand Medicaid coverage.

Medicaid expansions under the Affordable Care Act, or Obamacare, have resulted in health coverage for millions of low-income Americans in 30 states, researchers said.

Kentucky and Arkansas differed in their approaches to extending health coverage to low-income residents. Kentucky opted for a traditional Medicaid expansion, while Arkansas pursued a hybrid approach using Medicaid funding to enroll low-income people in private health insurance plans.

Despite the differences, the study found that low-income residents in both of those states enjoyed similar health improvements.

It doesn't seem to matter how states expand coverage; what matters is "whether or not you expand coverage" at all, explained Dr. Benjamin Sommers, the study's lead author. He's an assistant professor of health policy and economics at Harvard T.H. Chan School of Public Health in Boston.

The findings may help inform states that are still debating whether to expand Medicaid coverage as well as those weighing changes to their insurance expansions.

Newly elected Republican governors in Arkansas and Kentucky each have proposed restructuring their existing programs.

But researchers say the study adds to evidence that supports "staying the course" in those states.

Joseph Benitez is an assistant professor of health management and systems sciences at the University of Louisville. He said it's not surprising that some of the big effects of expanding Medicaid took a little longer to see.

"A lot of the people in the expansion population, especially people that have never had insurance coverage before, they're just getting used to having coverage and what to do with it," explained Benitez, who wasn't involved in the study.

Researchers surveyed nearly 9,000 low-income adults in Arkansas, Kentucky and Texas. The surveys were conducted from November 2013 through December 2015.

The uninsured rates dropped in Arkansas, from 42 percent to 14 percent from 2013 to 2015. In, Kentucky, those rates dropped from 40 percent to 9 percent. Texas saw only a modest decline, from 38.5 percent to 32 percent. The study authors noted that the research wasn't designed to prove a cause-and-effect relationship.

Still, compared with Texas, both Arkansas and Kentucky saw sharp improvements by 2015, including:

Increased access to a personal physician.
Reduced delays is getting care for cost reasons.
Regular care for chronic conditions, such as diabetes.
Fewer emergency department visits.
Reduced out-of-pocket medical spending.
Less trouble paying medical bills.

The researchers found that even in counties with shortages of primary-care physicians, expanding Medicaid made a difference.

"It certainly does not seem that it's an empty benefit," Sommers said. "This insurance expansion, even in those areas, is helping people get the care that they need."

The study was published online Aug. 8 in JAMA Internal Medicine.

The authors noted that the results may not be applicable to other states.

In an editorial in the same issue, health policy professors Frank Thompson and Joel Cantor of Rutgers University in New Brunswick, N.J., called for "continued close scrutiny" of states' various coverage expansions.

SOURCES: Benjamin Sommers, M.D., Ph.D., assistant professor, health policy and economics, Harvard T.H. Chan School of Public Health, Boston; Joseph Benitez, Ph.D., assistant professor, health management and systems sciences, University of Louisville; Aug. 8, 2016, press release, Harvard School of Public Health, Boston; Aug. 8, 2016, online, JAMA Internal Medicine

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