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Chart Book: The Far-Reaching Benefits of the Affordable Care Act’s Medicaid Expansion

August 6, 2020

So far, 34 states (including Washington, D.C.) have expanded Medicaid coverage to low-income adults under the Affordable Care Act (ACA). Three more states — Idaho, Nebraska, and Utah — will expand in 2020 as a result of voter-approved ballot initiatives.

A growing body of research shows that Medicaid expansion is yielding significant benefits for those gaining coverage, their families, and their communities. This infographic highlights a number of the studies.

The charts below show how Medicaid expansion leads to:

Increased Health Coverage

While all states saw coverage gains after the ACA’s major coverage provisions took effect in 2014, expansion states saw much larger drops in uninsured rates for low-income people.

Medicaid expansion has been especially critical for expanding coverage to those with opioid-use disorders. There’s an acute need for treatment for opioid-use disorders and other substance use disorders; a record 63,000 people died of drug overdoses in 2016, with 42,200 due to opioid use. Since Medicaid expansion took effect, the share of opioid-related hospitalizations in which the patient was uninsured has plummeted 79 percent in expansion states, compared to just 5 percent in non-expansion states.

Better Access to Health Care

Harvard University researchers periodically surveyed poor adults in Arkansas, Kentucky, and Texas about their access to care and their health. After Arkansas and Kentucky adopted the expansion, adults there were likelier to have a personal physician, receive care for chronic conditions, and receive an annual check-up — improvements not seen in Texas, which hasn’t expanded.

In 2008, Oregon expanded Medicaid to a limited number of low-income adults chosen in a lottery from among those eligible. This approach enabled researchers to compare outcomes for those selected through the lottery to otherwise-similar adults not selected. Researchers found that those enrolled in this limited Medicaid expansion had greater access to health care (including treatment for opioid-use disorders), more regular diagnostic and preventive screenings, and higher-quality care.

More than 476,000 Louisianans have enrolled in expansion coverage since the state adopted the expansion in 2016. These low-income adults are receiving critical mental health services and substance use disorder care, as well as diagnosis and treatment for diabetes, hypertension, and cancer.

The American Academy of Pediatrics recommends that children adhere to a regular schedule of well-child visits with their primary care physician. Researchers find that children, especially low-income children, are more likely to receive an annual well-child visit when their parent is enrolled in Medicaid. Having their own coverage likely helps parents navigate the health care system for both themselves and their children.

Better Health Outcomes, Including Fewer Premature Deaths

Medicaid expansion saved the lives of at least 19,200 adults aged 55 to 64 between 2014 and 2017, a landmark study finds. Conversely, more than 15,600 older adults died prematurely because of state decisions not to expand Medicaid.

Medicaid expansion ranks with other major public health interventions in terms of saving lives, the same landmark study shows. If all states had expanded Medicaid, the number of lives saved just among older adults in 2017 would nearly equal the number of lives saved by seatbelts among people of all ages.

The study’s findings are striking but not surprising. A large body of research has already documented how Medicaid expansion is improving access to care and health outcomes in ways that can help prevent premature deaths.

More Financial Security and Opportunities for Economic Mobility

Medicaid expansion has made it easier for people to afford needed health care, studies find — reducing medical debt, problems paying bills, and evictions.

The above-mentioned survey in Arkansas, Kentucky, and Texas found that in the expansion states of Arkansas and Kentucky, the shares of poor adults delaying health care due to cost, using the emergency room as a usual source of care, or having trouble paying medical bills fell relative to the non-expansion state of Texas.

Evictions fell about 20 percent in expansion states compared to non-expansion states after expansion took effect, a new study finds. By improving financial security, Medicaid expansion appears to be helping low-income renters avoid one of the most harmful consequences of financial stress. After eviction, renters often end up in homeless shelters, extremely poor-quality housing, or dangerous neighborhoods, or they must move frequently among homes of family and friends. All of these outcomes can cause long-term harm, especially for children.

Most low-income adults with Medicaid expansion coverage in Ohio and Michigan find that Medicaid makes it easier to look for work and easier to work once they have a job. Health coverage helps low-income adults address health problems such as diabetes or depression, which are a common reason why some people lose their job or cannot find one. These employment benefits are on top of the health benefits that Medicaid expansion enrollees in these states also cited.

Lower Uncompensated Care Costs

When a state’s uninsured rate falls, hospitals’ uncompensated care costs fall at roughly the same rate. Medicaid expansion states have seen larger reductions in both uninsured rates and uncompensated care costs. From 2013 to 2016 those costs fell by 55 percent in expansion states, compared to only 18 percent in non-expansion states.

Rural hospitals have seen large reductions in uncompensated care costs due to Medicaid expansion. Rural hospitals’ uncompensated care costs fell 43 percent in expansion states between 2013 and 2015, compared to 16 percent in non-expansion states.