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Has Expanding Medicaid Made People Healthier?

The research is exhaustive and yet simultaneously scarce. In some cases, it's even contradictory.

For all the debate about whether states should expand eligibility for Medicaid under the Affordable Care Act, it’s unclear whether doing so actually makes people healthier. Initial research into the impact of expansion is at the same time exhaustive and scarce, as well as seemingly contradictory in some cases.

But what we do know for certain is that as a result of the federal law about 16 million Americans have gained health coverage through Medicaid. And for the states that chose to expand their programs, there is ample evidence of increased usage of health services and improved affordability of care. For example, a study last year in The Journal of the American Medical Association looked at outcomes in Arkansas, Kentucky and Texas. Arkansas used Medicaid funds to offer private insurance to low-income individuals, Kentucky opted for a conventional Medicaid expansion and Texas did not expand its program. In the two states that did expand, people had more access to primary care, paid lower out-of-pocket health-care costs and rarely skipped medications.

One of the problems expanding Medicaid was supposed to address was the abuse of emergency care services. The same study found that ER usage declined in Arkansas and Kentucky. In Oregon, however, it increased soon after the state expanded Medicaid, particularly in the Portland area. Even after the first two years, usage has continued to grow, according to the Oregon Health Insurance Experiment, which has been tracking health outcomes in the state since its Medicaid expansion began.

There are several theories for why this is happening. For the newly insured, one explanation is that there’s typically “a lot of catching up that needs to be done,” says Ben Sommers, the lead researcher on the study. “While we knew that ER use would probably be pretty high after a state expanded Medicaid, the popular theory was that it would taper off in a couple years. But now my hunch is that’s not always the case.”

To overcome the spotty research that’s out there and to determine the impact of enrolling more people in Medicaid, Louisiana is putting a lot of resources into tracking the expansion’s effect. The state expanded its program last year and has implemented what it calls a Medicaid expansion dashboard. In mid-December, the dashboard was showing that under the expanded program nearly 360,000 Louisianans had obtained health coverage, more than 4,000 women had been screened for breast cancer, more than 3,600 people had received colon cancer screenings and more than 700 adults had been diagnosed with diabetes.

But not every state is willing or able to devote the resources Louisiana has to measuring the program’s impact. That’s especially true now that the future of the Affordable Care Act is up in the air with a new administration and Congress in Washington.

What’s more, it’s really too early to definitively answer the question of whether Medicaid expansion makes people healthier in the long run. Expansions are only a few years old. But for Rebekah Gee, who is Louisiana’s health and human services secretary, the dashboard makes one thing completely clear. “This shows that there is a demand for care,” she says, “and we do have the supply for it.”

Mattie covers all things health for Governing.

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