Medicaid Expansion Boosts Access to Care for Low-Income Residents
Low-income U.S. residents living in states that expanded Medicaid under the Affordable Care Act experienced greater improvements in health care access than those living in states that did not, according to a Commonwealth Fund study published Tuesday in Health Affairs, USA Today reports (Ungar, USA Today, 1/5).
For the study, researchers conducted telephone surveys from 2013 to 2014 of 5,665 Arkansas, Kentucky and Texas residents ages 19 to 64 who reported family incomes below 138% of the federal poverty level. The researchers asked respondents about:
- Access to a usual source of health care services;
- Cost-related barriers to care;
- Out-of-pocket spending;
- Self-reported mental and physical health;
- Type of insurance; and
- Use of care.
Survey respondents were also asked whether they had been diagnosed with a chronic condition, such as
- Diabetes; and
- Hypertension (Goodnough, New York Times, 1/5).
The study found that low-income individuals living in Arkansas and Kentucky -- which both expanded Medicaid -- experienced greater access to care than low-income individuals living in Texas, which did not expand Medicaid.
Kentucky has expanded its traditional Medicaid program under the ACA, whereas Arkansas has implemented an alternative Medicaid expansion through a federal waiver (USA Today, 1/5).
According to the study, from 2013 to 2014:
- Arkansas' share of uninsured, low-income adults decreased from 41.8% to 19.4%; and
- Kentucky's share of uninsured, low-income adults decreased from 40.2% to 12.4%.
During the same period, Arkansas and Kentucky experienced:
- Increases in their shares of low-income adults with chronic conditions regularly accessing care; and
- Decreases in their shares of such adults who reported skipping medications because of cost.
Further, the study noted that respondents who enrolled in Arkansas' and Kentucky's expanded Medicaid programs were less likely to rely on emergency departments for regular care from 2013 to 2014.
At the same time, low-income Kentucky residents reported significantly less trouble paying their medical bills once they were insured when compared with similar respondents in Arkansas. According to the study, the number of respondents who reported such difficulties decreased by 14.3% in Kentucky from 2013 to 2014, compared with a 7.6% drop in Arkansas (New York Times, 1/5).
Still, the study said that "there were no significant differences between Kentucky's traditional Medicaid expansion and Arkansas' private option, which suggests that both approaches improved access among low-income adults."
Meanwhile, the study noted that Arkansas' and Kentucky's combined uninsured rate decreased by 14 percentage points more than Texas' did from 2013 to 2014. In addition, the study found that:
- The share of respondents with chronic conditions that reported receiving regular care increased by nearly 12 percentage points more in Arkansas and Kentucky than in Texas;
- The share of respondents who reported not filling a prescription because of cost fell by nearly 10 percentage points more in Arkansas and Kentucky than in Texas; and
- The share of adults who reported struggling to pay medical bills fell by nearly nine percentage points more in Arkansas and Kentucky than in Texas (USA Today, 1/5).
The study concluded, "Deciding whether or not to expand matters much more than deciding how to expand." It noted, "Both Arkansas' private option and Kentucky’s traditional Medicaid expansion appear to be promising approaches that have thus far generated similar improvements in access care" (Levey, Los Angeles Times, 1/5).
Benjamin Sommers, the study's lead author and an assistant professor at the Harvard T.H. Chan School of Public Health, added, "The big message we found is an expansion -- any expansion -- makes a big difference compared with no expansion" (USA Today, 1/5).