Researchers: Medicaid Expansion Equals Better Coverage, Better Outcomes

Stories that caught our attention this week

California has long been a leader in expanding the eligibility criteria for enrollment in Medicaid. Under the Affordable Care Act (ACA), states can expand Medicaid to cover more adults with low incomes, and California was among the first to do so with its program, Medi-Cal. To date, 36 states and the District of Columbia have adopted the expansion, and newly released research suggests residents in those places are experiencing tangible improvements in their health and well-being as a result.Essential Coverage

As the country grapples with high rates of maternal and infant mortality, Medicaid expansion provides a reason for hope. Research summarized by the Georgetown University Center for Children and Families suggests that Medicaid expansion states saw a 50% greater decline in infant mortality than non-expansion states, with the greatest decline among Black babies. “States that have not expanded are really missing a clear opportunity to begin to address this unacceptable racial inequality among racial and ethnic mortalities,” said Adam Searing, a Georgetown associate professor and co-author of the report, according to FierceHealthcare.

States that made it easier to qualify for Medicaid provided reproductive-age women with increased health coverage, earlier prenatal care, and better overall care, which led to lower rates of maternal mortality. Among expansion states, the uninsured rate for women of childbearing age was almost half that of the non-expansion states. “Better coverage is the starting point for better care overall,” the Center emphasized in its report.

Racial Disparities Reduced

Research presented at the annual meeting of the American Society of Clinical Oncology also links Medicaid expansion “to a reduction in racial disparities in the care of cancer patients,” Laurie McGinley reports in the Washington Post. States that expanded Medicaid nearly eliminated the gap between Black and white patients in beginning treatment within a month of receiving diagnoses of any of eight advanced cancers, showing that timely initiation of cancer treatment is key to optimizing health outcomes.

Additionally, Medicaid expansion is linked to lower cardiovascular mortality rates, according to a new study published in JAMA Cardiology. While cardiovascular death rates among middle-aged adults in non-expansion states increased during the study period, they remained constant in expansion states, reports Lisa Rapaport for Reuters.

Extending coverage to people who were uninsured “could lead to better access to preventive care and protective heart medications such as aspirin and cholesterol medications,” said study author Sameed Khatana, MD, a fellow in cardiovascular medicine at the Hospital of the University of Pennsylvania. “Additionally, prior studies have shown that lack of insurance leads people to delay care, even when having a heart attack.”

Benefits Not Limited to Health Care

Researchers from Columbia University and Boston University show that the benefits of Medicaid expansion extend beyond health care. The researchers hypothesized that out-of-pocket medical costs could contribute to some people’s inability to pay rent and their subsequent evictions, and that gaining Medicaid benefits might help mitigate this situation among those struggling financially. At the annual research meeting of Academy Health, the researchers presented their finding that, indeed, there was a reduction in eviction rates following the Medicaid expansion in California. Specifically, they estimated that “for every 1,000 new Medicaid enrollees, there were 53 fewer evictions per year. Effects were concentrated among counties with the highest rates of uninsured residents.”

This study contributes to the growing body of research that links Medicaid expansion to financial stability. CHCF blogged about a few of these examples in 2017, including a Health Affairs study that showed the Medicaid expansion in California was associated with residents taking out fewer payday loans, a form of short-term, high-interest borrowing that is considered a major financial hazard.

Coverage Gains for Undocumented Adults in California

As early as January 1, 2020, even more Californians will have the opportunity to gain Medi-Cal coverage. The state budget, passed by lawmakers on June 13, would make California the first state to make all low-income residents under the age of 26 eligible for Medicaid regardless of immigration status.

In response to the legislature’s vote, CHCF President and CEO Sandra R. Hernández, MD, said in a statement, “At a time when the federal administration continues to erode health coverage for Americans and threaten hardworking immigrants, California is showing a different path is possible.”

Have you read any interesting studies about Medicaid expansion recently? Tweet at me with #EssentialCoverage or email me.