Medicaid expansion states see better health outcomes, study finds

Michigan expanded Medicaid under the ACA in 2014

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Newly published research makes the case that a smaller share of low-income adults in southern states that expanded Medicaid under the Affordable Care Act experienced declines in their physical and mental health than did their counterparts in southern states that did not expand.

“Health care policy experts and physicians have suspected this for a while, but with our study, we now have the actual evidence showing that non-expanding Southern states could materially improve population health if they accept expansion funds,” said John Graves, lead author of the study and an associate professor in health policy at Vanderbilt University School of Medicine, to WKNO radio near Memphis, Tenn.

The study was published in this month’s issue of the journal Health Affairs.

Medicaid expansion by state | Kaiser Family Foundation map

For several years, researchers have tried to determine what impact expanding Medicaid, a central feature of the ACA, was having on health outcomes. While studies have consistently demonstrated that expansion had improved access to health care and reduced financial strain on low-income populations, data on the health impact was less clear. While some published studies found some improvements, the majority detected none.

The new study, which Graves conducted with researchers at Harvard Medical School, may be the most comprehensive while addressing the limitations of previous work.

The longitudinal study draws on data collected from 15,536 low-income adults recruited primarily from community health centers in 12 southern states, four of which had expanded Medicaid and eight that had not. The data was collected from the patients in the periods both before and after Medicaid expansion, which states could begin expanding in 2014. Medicaid is jointly administered and financed by the federal and state governments.

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Expansion would have meant that all adults, not just pregnant women, the elderly and the disabled, would be eligible for Medicaid benefits if their income was below 138% of poverty (or an annual income of about $17,200 for a single adult).

Although the Affordable Care Act, also known as Obamacare, envisioned that all states would expand eligibility in accordance with the new law, a 2012 U.S. Supreme Court case made expansion optional. Many states opted not to, though through the years more and more states have come on board.

Today, only 36 states and Washington, D.C., including Michigan have expanded; 14 have not, half of them in the South. New work requirements went into effect in Michigan on Jan. 1, although Gov. Gretchen Whitmer opposes them and a federal court case is pending.

The new study demonstrates the consequences of a state’s decision on Medicaid expansion. It found that fewer respondents reported declines in both their physical and mental health status in Southern expansion states compared with non-expansion states.

In expansion states, 36.3% of those in the study reported declines in their physical health compared with 38.1% in non-expansion states.

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For mental health, 36.8% reported declines in expansion states while 38.9% did so in non-expansion states.

The authors of the report offered a couple of reasons why Medicaid expansion might have had a beneficial effect. While non-expansion states might have safety net providers — such as federally qualified health centers, which provide care regardless of income — such facilities generally do not offer the specialty care that Medicaid does.

The authors also point out that Medicaid programs often offer transportation services, enabling patients to get to medical appointments that might otherwise be difficult or impossible for them to attend.

Among the non-expansion states, the study found the rates of declines steepest in Tennessee and Alabama.

This story is from the Advance’s partner, Stateline, an initiative of the Pew Charitable Trusts.