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 Researchers found increased rates of insurance coverage, healthcare
use and chronic disease diagnoses among low-income adults in states
that expanded access to the government-funded health insurance
program.
"It looks like there is better medical care for these adults," said
lead author Laura Wherry, of the David Geffen School of Medicine at
the University of California, Los Angeles.
A key provision of the Affordable Care Act (ACA), sometimes referred
to as Obamacare, was to force states to expand their Medicaid
programs by 2014. But with a Supreme Court decision allowing states
to opt out of the expansion, only 26 states actually expanded their
Medicaid programs.
For the new study, the researchers analyzed 2010-2014 survey data
collected from low-income U.S. adults ages 19 to 64.
In the pre-expansion era, from 2010-2013, about 33 percent of people
had no insurance in states that ultimately expanded Medicaid,
compared to about 42 percent in states that opted out of expansion.
In 2014, those rates fell to about 18 percent in states that
expanded Medicaid and about 34 percent in states that didn't.
Overall, the uninsured rate fell by about 7 percentage points more
in states that expanded Medicaid than in those that didn't.
States with expanded Medicaid coverage also had a larger increase in
the proportion of people who thought their insurance coverage
improved over the previous year.
Additionally, there was evidence that people in states with expanded
Medicaid programs were using their coverage, because they had larger
increases in interactions with general physicians and overnight
hospital stays.
There were also more diagnoses of diabetes and high cholesterol in
states with expanded Medicaid programs.
Gaining insurance likely leads to more screening for these
conditions, and more diagnoses may lead to early treatment and
important downstream health effects, Dr. Jeffrey Kullgren wrote in
an editorial accompanying the new study.
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The new study shows what's happening in states that expand Medicaid
and "what is foregone by states that reject the ACA's opportunity to
expand Medicaid," write Kullgren, of the University of Michigan
Medical School and he Veterans Affairs Ann Arbor Health System.
While the new study did not show that people felt healthier in
expanded-Medicaid states, Wherry said it may be too early to see
changes in that measure.
"I think long-term follow up will be very important," she said.
The results help confirm the value of the ACA for people who obtain
this coverage, said John McDonough, who worked on the ACA but was
not involved with the new study.
He said the new findings likely won't convince reluctant states to
expand their Medicaid programs, however.
"It’s not about evidence at this point," said McDonough, who is a
professor at the Harvard T.H. Chan School of Public Health in
Boston. "It’s about a political fear over Obamacare that at this
point is not influenceable by meaningful evidence."
SOURCE: http://bit.ly/23TZvYd and http://bit.ly/23TZzay Annals of
Internal Medicine, online April 18, 2016.
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