17 Jul Medicaid Expansion Has Improved Access To Quality Care
While Medicaid expansion supporters are pleased with the recent developments in Maine and Virginia, there are concerns about the access to quality care as the Medicaid population expands. To address these concerns, a number of studies have been conducted to help guide the states considering expansion and those that are making adjustments to their current programs.
Medicaid expansion and rural areas
Since most of the rural populations are below the poverty line and uninsured, rural areas across the country rely on community health centers for primary care. The increased federal funding from the Affordable Care Act and Medicaid expansion were thought to be solutions for improving the access and quality of care for these areas.
In a report from Health Affairs titled, Medicaid Expansion And Community Health Centers: Care Quality And Service Use Increased For Rural Patients, researchers looked into the changes in quality and access between 2011 and 2015. After comparing community health centers from states that expanded with centers in states that did not, the report indicated that patients covered under Medicaid rose to 13% and uninsured patients decreased by 11%.
Researchers also compared urban centers from areas that expanded Medicaid with urban centers in areas that did not, but the study did not discover any significant changes to the quality of care.
Unlike the urban community health centers, rural centers from states that expanded Medicaid saw significant improvement. Researches believe that these improvements may be a result of more affordable pharmaceuticals under Medicaid or possibly due to the fact that insurance access to care makes visits to health professionals less costly.
Are more conservative versions of Medicaid working?
Health Indiana Plan 2.0 was the result of the state expanding Medicaid by way of the 1115 waiver process. In order to qualify, program enrollees are required to contribute to a health savings account. Whenever an enrollee fails to make a payment, their benefits are reduced. Additionally, enrollees that make more than the poverty line are locked out of coverage for 6 months if they miss a payment.
Indiana University researched the effects of the state’s decision and compared it to other states that expanded. By using data from the American Community Survey, researches looked to see if adults between the ages of 18 and 64 had insurance coverage or Medicaid coverage from 2009 to 2016. According to their research, states that expanded their Medicaid programs experienced larger gains in comparison to states that did not. Generally, states that had higher insurance coverage rates prior to expanding saw more gains. Out of 27 states, Indiana ranked in the middle at 13.
Despite Indiana’s additional requirements for coverage, the state experienced notable Medicaid coverage gains. Whether or not the gains could have been larger without the requirements could not be determined. Also, Indiana’s cost-sharing requirements could be the cause for the state’s underperformance.
A 30,000 foot view of Medicaid after expansion
From the beginning of Medicaid expansion, there have been 77 studies published with 440 unique analyses. Over half of the studies suggest that the effects of Medicaid expansion are in line with the goals of the Affordable Care Act. 35% of the studies indicated no significant discoveries and 4% discovered a negative effect after expanding Medicaid.
Up to this point, the studies that have been conducted indicate that the effects of Medicaid expansion have been positive. The lead author of Indiana University’s study, The Effects Of Medicaid Expansion Under The ACA: A Systematic Review, Olena Mazurenko says “With dozens of scientific analyses spanning multiple years, the best evidence we currently have suggests that Medicaid expansion greatly improved access to care, generally improved quality of care, and to a lesser degree, positively affected people’s health.”