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More Evidence of Medicaid Expansion’s Positive Effects

Poor adults in states that have expanded Medicaid as part of health reform have greater access to health care services and fewer problems paying their medical bills, and hospitals there are admitting fewer uninsured patients, two new studies published in Health Affairs show.  These findings provide more evidence that Medicaid expansion is improving the health of beneficiaries, as well as the budgets of many expansion states.  It’s a powerful lesson for the 20 states that haven’t yet expanded.

The first study, by Harvard University researchers, surveyed low-income non-elderly adults in Arkansas and Kentucky (which have expanded Medicaid) and Texas (which hasn’t).  The share of residents with a personal doctor rose by 8 percentage points more in the expansion states than in Texas between 2013 and 2014.  Similarly, the share of residents receiving a primary care checkup rose 7 points more in the expansion states, and the share receiving care for a chronic condition rose 11 points more.  

Expanding Medicaid helped people’s pocketbooks as well.  The share of people who had trouble paying their medical bills fell by 9 percentage points more in the expansion states than in Texas. 

These findings are notable because the three states had similar coverage landscapes before the Medicaid expansion took effect in 2014, with roughly 40 percent of their poor non-elderly adults uninsured.  By the end of 2014, Arkansas’ uninsured rate among this population had dropped from 42 percent to 19 percent and Kentucky’s had dropped from 40 percent to 12 percent, the study found.  Texas’ uninsured rate dropped as well (from 38 percent to 27 percent), reflecting the availability of subsidized marketplace coverage and other factors, but its coverage gains were much more limited due to the state’s failure to expand Medicaid. 

Other government and private surveys have also found much bigger coverage gains in expansion states.

The second new study, by researchers at Vanderbilt University and the University of Michigan, found that hospitals in expansion states experienced “dramatic decreases in uninsured hospital stays” between 2013 and 2014.  That’s consistent with other research showing that because expanding Medicaid shrinks the ranks of the uninsured, it has reduced hospitals’ uncompensated care burden.

As state legislative sessions get underway and governors in states like Alabama, Louisiana, South Dakota, and Wyoming prepare to push for Medicaid expansion in 2016, this latest research underscores why expansion is the right choice.