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Expanding Medicaid Seems to Benefit More Than Recipients

Advocate Masthead

GAO report finds fewer unmet medical needs overall in states that expanded eligibility

Nov. 2, 2018 (ACP) – A new report suggests that the Affordable Care Act's expansion of Medicaid eligibility may be benefiting many more people than the low-income Americans who now have health coverage. In expansion states, uninsured people seem to have better access to health care, too.

The report's findings provide more evidence that Medicaid expansion has had a positive effect on American health care. The American College of Physicians has enthusiastically supported the expansion of Medicaid, which has been implemented in 33 states and the District of Columbia, according to a tally by the Kaiser Family Foundation. Another 3 states – Idaho, Nebraska and Utah – are considering expansion.

The 71-page report, released by the Government Accountability Office (GAO) in mid-October, examined access to health care among low-income adults in both expansion and non-expansion states. That included 5.6 million people, 19 to 64 years of age, who did not have health insurance but would have been eligible for expanded Medicare. About 1.9 million lived in states that chose to expand Medicaid eligibility, and 3.7 million lived in states that did not expand Medicaid.

“We found that low-income adults in states that expanded Medicaid generally reported better access to health care,” the GAO wrote in its report. “For example, they were less likely to report having unmet medical needs (such as not being able to afford their prescriptions) – whether or not they were insured.”

Specifically, the report found that 40 percent of low-income adults in non-expansion states reported having unmet medical needs – 63 percent of the uninsured, 34 percent of those on Medicaid and 25 percent of those with private health insurance.

In contrast, low-income adults in expansion states appeared to be faring better, even the uninsured. Overall, 26 percent reported having unmet medical needs – 50 percent of the uninsured, 27 percent of those on Medicaid and 18 percent of those with private insurance.

The study also examined the percentages of low-income adults who reported having trouble affording health care within the past 12 months. In expansion states, nine percent reported not being able to get medical care due to costs, compared with 20 percent of those in non-expansion states. In expansion states, 11 percent reported delaying medical care due to costs, versus 21 percent in non-expansion states.

These findings suggest – but don't confirm – that Medicaid expansion is having a halo effect by improving health care access beyond those who are now able to be covered under the program.

Joel W. Hay, a professor of health economics and policy at the University of Southern California, said that the findings of the report aren't unexpected. “It is hardly surprising that Medicaid expansion will create more covered lives with better financial access to health care,” he said.

Hay cautioned, however, that better access to health care doesn't necessarily translate to better health care or better health outcomes.

Why might uninsured people – who haven't directly benefited from Medicaid expansion – fare better in expansion states?

“The states that expanded Medicaid may have more faith in government programs to resolve society's problems and may actually attract similar-minded people to execute and participate in those programs,” Hay said.

More Information

The GAO report, “Access to Health Care for Low-Income Adults in States with and without Expanded Eligibility,” is available on the agency's website.

A state-by-state tally of Medicaid expansion is available on the Kaiser Family Foundation website.

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Back to the November 02, 2018 issue of ACP Advocate