Here's How Medicaid Expansion Is Making People's Lives Better

NEW YORK, NY — States that expanded Medicaid, a key feature of President Obama's Affordable Care Act, now provide health insurance to more than 14 million people additional people compared to before the law passed. While the program remains controversial — 18 states still decline to expand Medicaid beyond in its initial limited scope — a growing amount of research shows that the coverage helps makes its recipients' lives better.

A new study conducted by Harvard T.H. Chan School of Public Health, published this week by the Journal of the American Medical Association, found that Medicaid expansion was linked to better access to high-quality surgery.

"What was most striking was that we saw significant improvements in the treatment of surgical conditions fairly quickly, less than two years after states expanded Medicaid coverage," Harvard research fellow and lead author of the study Andrew Loehrer said.

The study examined data from about 300,000 patients in 42 states over the course of five years. It focused on patients who had relatively common surgical needs, such as appendicitis. In states that expanded Medicaid, hospitals saw a decrease of 7.5 percent in the chance that patients coming in were uninsured. Patients' chance of seeking care earlier — reducing the chance of complications — went up about 1.8 percent; their chance of receiving optimal care went up 2.6 percent.

While these percentages are relatively small on the scale of the millions of people who receive care each year, the actual number of individuals affected by improved health care in a year can number in the tens of thousands or more.

This week, Oregon voters approved a new tax to continue financing Medicaid expansion. Maine voted to expand Medicaid in November after rejecting it for years. Nationally, though, there have been moves to reduce Medicaid's scope, such as the Trump administration's decision to let states place work requirements for individuals on the program.

"The fate of the ACA and Medicaid remains a key policy debate," said Benjamin Sommers, associate professor of health policy and senior author of the paper. "As policymakers continue to discuss major changes to the ACA, and the Trump administration advances reforms that could lead to fewer people covered by Medicaid, our findings provide important new evidence that Medicaid expansion is improving the quality of care for serious conditions affecting tens of thousands of Americans every year."

The study from Harvard T.H. Chan School of Public Health is only the most recent to research showing a range of benefits from the ACA policy.

In November 2017, the journal Medical Care published a study from the University of Pittsburgh Graduate School of Public Health showing that Medicaid expansion made it more likely that low-income people would quit smoking. It found that 8.1 percent of newly covered low-income adults quit smoking, while only 6 percent of that population were able to break the habit in Medicaid expansion states. With smoking responsible for 9 percent of health-care spending in the United States, reductions in smoking can have enormous benefits.

"The sizable increase we found in smoking cessation might lead to significant reductions in death and diseases caused by smoking, and the taxpayer-funded health care expenditures that come with treating them," said Marian Jarlenski, a senior author of the paper.

Another study from Duke University Medical Center found that Medicaid expansion states cut the rate of uninsured cancer patients receiving radiation from 4.4 percent to 2.1 percent. And researchers from Johns Hopkins University and University of Pittsburgh found that Medicaid expansion didn't just benefit the recipients — the children of newly enrolled Medicaid patients were more likely to receive preventive care.

It may not be that surprising that expanding a health insurance program would bring benefits — though many have argued that the program is virtually useless.

It may be more surprising, however, that some analyses suggest that there may be fiscal benefits to Medicaid.

Indiana University researchers found, for instance, that expanding Medicaid reduced government spending elsewhere. When states expanded Medicaid, researchers found that people were less likely to sign up for Supplemental Security Income — government payments to people with disabilities.

"Reduced reliance on SSI generates savings at the federal and state levels because, for people who are on Medicaid but not SSI, the government covers only health care costs and doesn't disburse other cash benefits," said researcher Kosali Simon of the Indiana University. So even if governments wanted to cut costs by scaling back Medicaid, they might find they have to pay out more for other programs.

Hospitals' finances also seemed to improve under Medicaid. According to a study by the American Hospital Association Annual Survey, hospitals in Medicaid expansion states saw an average reduction in unpaid medical bills of about $2.8 million.

As the program has grown, more and more people are committed to its success. About 60 percent of people are now connected to Medicaid either personally, through a family member or through a close friend, according a study from the University of Chicago published in December. Ninety percent say they would rely on the program, if needed. These numbers suggest that program's expansion is likely to stick around.

"Medicaid constituents and their allies are primed to be mobilized to not only protect the program against retrenchment but also to proactively fight for expansion," said Colleen M. Grogan, a professor in the university's School of Social Service Administration.

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