By Harold Berman, J.D.
According to the Government Accountability Office (GAO), about 5.6 million uninsured low-income adults would have qualified for expanded Medicaid coverage under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) due to income level in 2016. About 1.9 million of these adults lived in Medicaid expansion states. The GAO found that adults in expansion states reported better access to care and fewer financial barriers to obtaining care (GAO Report, GAO-18-607, October 15, 2018).
Demographics. According to the GAO, over half of uninsured, low-income adults were male, over half were employed, and over half had incomes of less than 100 percent of the federal poverty level. However, expansion states had significantly larger percentages of uninsured, low-income males than did non-expansion states.
Access to health care. Low-income adults in expansion states were less likely to report that they had unmet medical needs than were similarly situated adults in non-expansion states (26% versus 40%). Additionally, insured low-income adults in both sets of states were less likely to report having unmet medical needs than those who were uninsured (34% versus 50%).
Low-income adults in expansion states were less likely to report having financial barriers to health care than in non-expansion states (9% versus 20%), and the insured were less likely to report financial barriers than the uninsured (12% versus 27%). Among the uninsured, those in expansion states were less likely to report financial barriers than in non-expansion states.
The 2016 data also showed that low-income adults in expansion states more often reported having a usual place of care for when they were sick than those in non-expansion states (82% versus 68%). Those who were insured were more likely to report a usual place of care than those who were uninsured (78% versus 46%). Among the uninsured, there was little difference between those in expansion and non-expansion states in terms of reporting a usual place of care or receiving health care services. However, more low-income individuals in expansion than in non-expansion states reported visiting or having spoken to a health care professional about their health.
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