Health Reform WK-EDGE Expansion states see bigger drop in uninsured, better care access
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Monday, July 4, 2016

Expansion states see bigger drop in uninsured, better care access

By Kayla R. Bryant, J.D.

States that chose to expand their Medicaid programs to include low-income adults saw a 49.5 percent decline in the uninsured rate, while non-expansion states saw a 33.8 percent decline following the implementation of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). HHS’ Assistant Secretary for Planning and Evaluation (ASPE) assessed the impact of Medicaid expansion on coverage and access to care, finding that enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) has grown by 26.5 percent since the first open enrollment period (ASPEReport, June 20, 2016).

Enrollment. Expansion states experienced 35.5 percent enrollment growth in Medicaid/CHIP, with non-expansion states at 10.4 percent. This enrollment increase is associated with a drop in the uninsured rate. The rate in expansion states dropped from 18.5 percent to 9.3 percent, while in non-expansion states the rate was 23.3 percent and is now 15.4 percent.

In addition, children ages 18 and under gained coverage, dropping the uninsured rate for this population from 7.0 percent to 5.8 percent between 2013 and 2014. The ASPE associates the higher enrollment rate for children in expansion states with the increased likelihood of adults to enroll their children while enrolling themselves.

Access. A usual source of care, such as a particular office, clinic, or provider, is associated with better access to care. Those with a stable source of health care are more likely to obtain preventive services and monitor chronic conditions. Increased Medicaid enrollment was found to have also increased the number of low-income adults that have a personal physician. In expansion states, a 41 percent increase in preventive service visits was observed. Medicaid prescription rates increased 25.4 percent in expansion states, and cost-related barriers to dental care and earlier diagnosis and treatment of diabetes were also observed. The ASPE believes that the temporary reimbursement increase for providers treating Medicaid enrollees resulted in improved appointment availability and decreased wait times in some states.

Affordability and quality. Over three-quarters of new enrollees post-expansion could not have accessed or afforded care without Medicaid coverage, and fewer people reported difficulties paying medical bills. The rate of unmet medical needs among low-income adults is still high post-expansion at 44.8 percent, but this represents over a 10 percent decrease from pre-expansion reporting. The decline in unmet needs was associated with generous cost-sharing protections under Medicaid. Over half of newly enrolled adults reported that they were better off than before enrollment, and 93 percent were at least somewhat satisfied with their health plans.

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