Report: Medicaid Expansion Could Boost Residents’ Overall Health

Expanding Medicaid under the Affordable Care Act could help states improve the overall health of their residents, according to the Commonwealth Fund's Scorecard on State Health System Performance published Wednesday, USA Today reports (Kennedy, USA Today, 4/30).

For the report, the Commonwealth Fund examined 42 various indicators of health access, costs, outcomes and quality in each state from 2007 to 2012, including:

• 30-day hospital mortality rates;
• Cancer-related death rates;
• Obesity rates;
• Preventable hospital visits;
• Smoking rates:
• Suicide rates;
• Vaccination rates; and
• Other factors.

States' performance scores on each indicator were averaged together and then compiled and compared with other states to determine rankings (Pittman, MedPage Today, 4/30).

Medicaid, Medicare Findings

According to the report, nine of the top-scoring 13 states have expanded Medicaid under the ACA, while three of the lowest-scoring 12 states chose not to expand their Medicaid programs. Further, just eight of the top 25 ranked states have not expanded Medicaid, according to the report (USA Today, 4/30).

Findings on Overall Health

The report found wide differences between the top- and bottom-ranking states, with disparities occurring even within some states. In the majority of the country, health measures declined in as many areas as they enhanced.

The report found that the proportion of U.S. adults getting recommended levels of care declined in 30 states, while the percentage of adults who did not have health care because of affordability rose in 42 states (MedPage Today, 4/30). In states with the highest rates of uninsured adults, around 19% did not receive necessary health care.

Specifically, states in which at least 29% of adult residents were uninsured included:

• Florida;
• Nevada;
• New Mexico; and
• Texas (USA Today, 4/30).

The report also found that:

• No significant increases or declines existed in states on 24 of 34 indicators for which longitudinal data existed;
• Decreases in cancer-related deaths and premature mortality rates indicate that medical care is helping;
• Only a few states -- including Colorado, Maryland, New Hampshire and New York -- showed net improvements among multiple indicators;
• States showed an overall decrease in the proportion of children with primary care "medical home[s];" and
• Health outcome disparities between high- and low-income residents remained significant (MedPage Today, 4/30).

According to the report, the worst-performing states included:

• Mississippi, which ranked in the bottom 25% in all categories; and
• Arkansas, Louisiana and Oklahoma, which all ranked in the bottom 25% for all categories except one.

The top performing states were Hawaii, Massachusetts, Minnesota, New Hampshire and Vermont, which have consistently ranked among the top states for several years, according to researchers (USA Today, 4/30).

Suggestions

The report noted that overall health in states stagnated or declined in the few years leading up to the ACA's implementation but suggested that the law could significantly improve health systems' performance in states that fully embrace the law and expand Medicaid (MedPage Today, 4/30).

Researchers suggested that states could see improvements "through Medicaid and high-quality private insurance choices in the [ACA's insurance exchanges]."

Researchers also noted that "cost-related barriers to care should ease for individuals and families who gain coverage under the" ACA.

However, the study warned that health disparities could widen between states "if such health system reforms and innovations are not evenly spread across states" (USA Today, 4/30).