ACA Medicaid Expansion Boosted Care Access, Patient Outcomes

June 09, 2017 - Low-income adults taking advantage of the Affordable Care Act’s Medicaid expansion experience more financial stability and better outcomes, according to a new study from the Harvard T. H. Chan School of Public Health.

“Our four years of data indicate that 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 study reported.

The study looked at low income adults in Arkansas, Kentucky and Texas.

All three states had an uninsured rate of over 40 percent prior to the ACA Medicaid expansion in 2013.

Both Arkansas and Kentucky participated in the ACA Medicaid expansion, and lead the nation with the two largest percentage decreases in their uninsured rates. 

In 2016, twelve percent of Arkansas patients and seven percent of people in Kentucky lacked insurance, representing a drop of more than 20 percent since 2014.

Texas was chosen as a comparison state for the study because it matched similar pre-expansion statistics, but did not participate in the ACA Medicaid expansion.  Texas currently has a 28 percent uninsured rate, a 6.5 percent reduction since 2013. 

Because of their involvement with the Medicaid expansion, both Arkansas and Kentucky have seen a 29 percent increase in the number of residents with a personal doctor, and a 24 percent increase in the number who have attended an annual primary care visit in the past calendar year. 

Research also showed a 41 percent increase in previously uninsured residents who now have a regular source of healthcare.  This most improved regular access to healthcare was seen for those with chronic conditions, including the high proportion of patients suffering from depression, hypertension, diabetes, asthma, and COPD.  These individuals reported greater affordability and regularity of care, medication adherence, and self-reported health. 

There were also significant increases in overall preventive health visits and screenings. 

The study did indicate increased difficulty with making appointments to see healthcare specialist in 2016.   This data matched recent national studies which showed an increase in appointment waiting times for specialists.  Researchers concluded that the increase in wait times could be due in part to a stagnant supply of specialists, versus an increase of patients with healthcare coverage seeking appointments.

The costs of care also decreased, the researchers found.  The study found an average out-of-pocket spending reduction of $337 per year.  As a result, 25 percent fewer patients reported having trouble paying their medical bills.

Overall, residents of Arkansas and Kentucky were now also 42 percent more likely to report they’re in “excellent” health.   

Kentucky has been a national success story for the ACA Medicaid expansion.  In 2016, nearly one-third of Kentucky’s population received healthcare through an ACA Medicaid expansion program.

Despite future uncertainty over funding for Medicaid expansion, the study lends support to the notion that exposure to Medicaid expansion coverage provides adults with increased access and utilization of healthcare services.   These improvements were most measurable in two traditionally vulnerable populations, low-income adults and those with chronic conditions