Health Reform WK-EDGE Report considers the association of Medicaid expansion on improved health of low-income residents
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Thursday, September 19, 2019

Report considers the association of Medicaid expansion on improved health of low-income residents

By Sheryl Allenson, J.D.

Some studies find that, five years after implementation of Medicaid expansion, there is evidence that it is associated with improved health in low-income Unites States residents.

A report, analyzing three groups of studies, found "rigorous evidence" that Medicaid expansion is tied to improved health in low-income residents, according to a report in the Journal of the American Medical Association (JAMA). Notwithstanding, the report found that literature is less-definitive than other evidence that supports the finding that Medicaid increases access to care and promotes financial well-being.

The first measure considered was self-reported health, arising from government surveys that asked individuals to rate their health using a multiple-choice survey. The report detailed the advantages of using this measure and noted that while earlier studies had "mixed results" the majority of more recent studies found that Medicaid expansion was correlated to improved self-reported health.

In its review of condition-specific health outcomes, JAMA reported that in one study that used government-collected health care data, Medicaid expansion was associated with improved control of some conditions, but not others. Looking at another study, in this case regarding end-stage renal disease (ESRD), the report indicated that Medicaid expansion was associated with "a significant increase in the quality of predialysis care," as well as a relative mortality reduction. A study that used hospital registry data to examine patient treatment arising out of five common surgical conditions found that Medicaid expansion correlated with patients making trips to the hospital earlier, increased receipt of "optimal care," and in some instances, improved outcomes.

The report indicated that despite these findings, there was a shared methodological challenge, noting that these could lead to faulty conclusions. Nonetheless, the report dismissed the idea that the registry data and medical records could not be used to "assess the relationship between Medicaid expansion and health outcomes," laying out means by which the study could assess for any major composition shifts.

Although the report also considered population-level survival, it noted that the Patient Portability and Affordable Care Act (ACA) presented methodological challenges, because there was "no obvious control group" for the ACA as a whole. Nonetheless, the report detailed the findings of two studies that provided suggestive evidence that after Medicaid expansion, population-level mortality declined.

The report points to an increasing number of studies that provide "rigorous evidence," to support the conclusion that Medicaid expansion is associated with improved health of low-income residents in the various categories detailed therein. However, according to the report, these studies are less definitive than those which conclude that Medicaid expansion leads to access to care and that it promotes financial well-being.

According to the report, the conversation surrounding the association between Medicaid expansion and improved health should address two questions. First, studies should focus on whether low-income populations have increased health following Medicaid coverage. Second, studies should question whether Medicaid expansion is the most effective or efficient way to improve the health of the low-income population, and how this compares to other aspects of the United States health care system.

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