Analysis Finds Trade-Offs Associated With ACA-Enabled Medicaid, Marketplace Expansion

Following passage of the Affordable Care Act (ACA) in 2010, the percentage of near-poor Americans with health insurance increased at approximately the same rate for people who became eligible for Medicaid and for people who became eligible for subsidized private insurance through ACA marketplaces, an AHRQ analysis found. The analysis, published in today’s Health Affairs, found that as of 2015, the uninsurance rate among nonelderly near-poor adults – those with incomes between 100 and 138 percent of federal poverty guidelines – declined 22 percentage points in states that expanded Medicaid, while the rate declined 18 percentage points in states that offered this group subsidized private coverage. Researchers also found that among these adults, those in Medicaid expansion states experienced larger reductions in out-of-pocket spending, but faced greater difficulty accessing physician care compared with those in nonexpansion states. Access the abstract.

Medicaid Expansion And Marketplace Eligibility Both Increased Coverage, With Trade-Offs In Access, Affordability

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PUBLISHED:DECEMBER 2017No Accesshttps://doi.org/10.1377/hlthaff.2017.0830

ABSTRACT

Affordable Care Act (ACA) provisions implemented in 2014 provide a valuable case study regarding the merits of using public versus subsidized private insurance to help low-income people obtain and finance health care. In particular, nonelderly adults with incomes of 100–138 percent of the federal poverty level gained Medicaid eligibility if they lived in states that implemented the ACA’s Medicaid expansion, whereas those in nonexpansion states became eligible for subsidized Marketplace coverage. Using data for 2008–15 from the National Health Interview Survey, we found that as of 2015, adults with family incomes in this range had experienced large declines in uninsurance rates in both expansion and nonexpansion states (the adjusted declines were 22 percentage points and 18 percentage points, respectively). Adults in expansion and nonexpansion states also experienced similar increases in having a usual source of care and primary care visits, and similar reductions in delayed receipt of medical care due to cost. There were, however, important differences: Adults in expansion states experienced larger reductions in out-of-pocket spending but also faced greater difficulty accessing physician care relative to adults in nonexpansion states.