Finally, Some Answers on the Effects of Medicaid Expansion

The following originally appeared on The Upshot (copyright 2018, The New York Times Company).

The Medicaid logjam appears to be breaking.

When the Affordable Care Act first invited states to make more low-income people eligible for Medicaid, pretty much all the blue states said yes, but many red ones said no. Now, the Maine Legislature seems poised to overcome Gov. Paul LePage’s opposition to expanding the program. Just weeks ago, Virginia voted to expand Medicaid as well. They would join 32 states that have already expanded the program, and three others actively considering it.

But many are still arguing about whether the expansion actually provides adequate care for more Americans. Some believe it really doesn’t improve access to health care. Others believe that even if it does, it doesn’t improve the quality of that care.

Dozens of studies are starting to answer those questions, including a number in the June issue of the journal Health Affairs. Such studies can be useful to states that may want to jump into expansion, perhaps with their own conservative stamp. They may also prove useful to others that want to tinker with already existing programs to make things better in different areas.

Is Medicaid expansion helping rural areas?

Community health centers have long provided primary care to millions of patients in underserved areas across the United States, both urban and rural. Because most of their patients are poor or uninsured, they were expected to benefit from the Medicaid expansion. There was also hope that Obamacare’s increase in federal funding for such centers would lead to improvements in rural areas that have been difficult to reach.

Using data available each year from community health centers that receive federal funding, researchers explored how access and quality changed from 2011 to 2015, before and after the Medicaid expansion. They compared centers in states where expansion had taken place with those in states where it had not, and found that in the expansion states, the percentage of uninsured patients dropped more than 11 points. The percentage of patients covered by Medicaid increased by more than 13 points.

Community health centers in urban areas where Medicaid expanded saw no significant changes in quality compared with those in urban areas in nonexpansion states. But rural health centers in states that expanded experienced significant gains. More patients with asthma received appropriate drug treatment (4 percent more), more patients received appropriate weight screening and follow-up (7 percent more), and more patients with hypertension gained control over their blood pressure (2 percent more). Gains among rural Hispanic patients were even larger than those among white patients.

Some of these gains might be because pharmaceutical treatment became much more affordable with Medicaid. More of these gains, however, may be because insurance access makes visits to health professionals easier. Extrapolated to the whole population, the Medicaid expansion appears to have resulted in about 427,000 extra visits for depression and 457,000 extra visits for high blood pressure in rural health centers alone.

These visits and improvements are occurring in areas of the country that tend to be underserved and hard to affect. The visits could also be substantially increased if holdout states expanded Medicaid.

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