Medicaid expansion sees results
More low-income adults are getting needed healthcare, a study finds, as GOP pushes for broad cuts.
WASHINGTON — As the Trump administration and congressional Republicans push for sweeping cuts to the Medicaid safety net, a new study provides additional evidence the program is significantly improving poor Americans’ access to vital medical care.
Low-income patients in Arkansas and Kentucky, two states that expanded Medicaid under the Affordable Care Act, are getting checkups more regularly and delaying care for financial reasons less frequently.
Poor patients with chronic illnesses such diabetes are also seeking more regular care for their diseases, according to the study, published Wednesday in the journal Health Affairs.
By contrast, low-income patients in Texas, which has not expanded Medicaid through Obamacare, have seen few gains in access to care in recent years, the researchers found.
“With the changes being debated in Washington, we think this is very important to understanding the impact that [a repeal of Obamacare] might have on the most vulnerable people,” said Harvard University’s Dr. Benjamin Sommers, the lead author of the study.
House Republicans this month voted to roll back Obamacare with legislation that would slash nearly $900 billion in federal aid to state Medicaid programs over the next decade, a roughly 25% cut to a program that provides coverage to more than 70 million poor Americans.
Senate Republicans are debating their own version of the legislation.
Medicaid is a pillar of Obamacare’s program for guaranteeing coverage and has helped drive a historic drop in the nation’s uninsured rate. Surveys indicate at least 20 million previously uninsured Americans have gained coverage since 2014.
The law makes hundreds of billions of federal dollars available to states to extend Medicaid coverage to poor adults, a population that had been largely excluded from the safety net program.
Medicaid eligibility historically was limited to vulnerable populations including low-income children, pregnant women, the elderly and people with disabilities.
The number of states that have expanded Medicaid under the law has reached 31. But GOP opposition has left nearly 3 million lowincome Americans without insurance in the 19 states that haven’t expanded Medicaid, according to an analysis by the nonprofit Kaiser Family Foundation.
Many Republicans, including Health and Human Services Secretary Tom Price, say the program is ineffective. But a growing body of research contradicts that claim, including the new study, which relies on annual surveys of poor residents of Arkansas, Kentucky and Texas starting in 2013, the year before Obamacare’s coverage expansion began.
“The ACA’s coverage expansion to low-income adults was associated with significant improvements in access to primary care and medications, affordability of care, preventive visits, screening tests and self-reported health,” the authors conclude.
In Arkansas and Kentucky, for example, the share of poor adults who had checkups in the last year jumped by about 12 percentage points between 2013 and 2016, increasing in Arkansas from 45% to nearly 57% and in Kentucky from 46% to 58%. By contrast, in Texas, poor adults who got checkups remained at 51%.
Other research has found similar gains in Medicaid patients, according to a Kaiser Family Foundation review of more than 100 studies on the impact of Obamacare Medicaid expansions.
Though some research has shown less impact, “most research demonstrates that Medicaid expansion positively impacts access to care and utilization of healthcare services among the low-income population,” Kaiser’s review concludes.