Medicaid expansion has been linked to a number of health and economic benefits over the past few years, and a pair of studies recently published in the journal Health Affairs provide evidence that expanding the federal program has positive effects on both volume, and care quality, particularly in more rural areas.
The findings are being published soon after the Virginia legislature voted to expand Medicaid, joining 32 states and Washington D.C. in accepting federal dollars to do so under the Affordable Care Act. The decision comes as the Trump administration and many congressional Republicans seek to shrink the program through repeals, spending caps and block grants, or through work requirements and other waivers to limit eligibility.
The first study, led by a Boston University School of Public Health researcher, found that the initial two years of Medicaid expansion under the ACA, 2014 and 2015, bolstered the quality and receipt of care for millions of low-income, rural patients.
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The research looked at community health centers, which mostly serve low-income and disproportionately uninsured patients. The authors found community health centers in expansion states saw an 11.44 percentage point decline in uninsurance and a 13.15 percent increase in Medicaid coverage among their patients after two years of expansion, compared with similar community health centers in non-expansion states.
Rural community health centers also showed improvements in asthma treatment, body mass index screening and follow-up, and hypertension control, along with substantial increases in 18 types of visits -- particularly for mammograms, abnormal breast findings, alcohol-related disorder and other substance use disorders.
At rural community health centers, Medicaid expansion was linked to about 437,000 visits for depression, 141,000 visits for Pap testing and 457,000 visits for hypertension over the two-year period, "totals that would likely be much higher if more states had expanded Medicaid," the authors wrote.
Community health centers in rural areas also saw improvements over their non-expansion counterparts in several treatment areas, including a 3.5 percentage point increase in patients with asthma receiving appropriate pharmacologic treatment; a 6.7 percentage point increase in adults receiving a BMI screening and follow-up if needed; and a marginally significant increase in the percentage of patients receiving a Pap test. The researchers also found a 2.1 percent increase in blood pressure control for hypertensive patients, with the greatest relative gains in this area seen among Hispanic patients in rural areas, who had a 5.2 percentage point increase.
The second Health Affairs study, this from researchers at Indiana University, found expansion of Medicaid under the ACA was linked to increases in health coverage, use of health services and quality of care, analyzing 77 peer-reviewed studies of expansion's effects to arrive at this conclusion.
Researchers found Medicaid expansion was related to increased insurance coverage among all potentially eligible individuals, regardless of race, age, marital status or income. They also said that health insurance gains were largest for adults without a college degree; short- and long-term uninsurance rates declined; use of primary care, mental health services and preventive care among Medicaid enrollees went up; more low- and moderate-income adults had a regular source of care; and reliance on emergency departments decreased.
Despite the findings, which are consistent with previous studies, some states have struggled to push through Medicaid expansion plans despite mounting evidence that covering more people pays off in the long run.