Health Reform WK-EDGE State grades improve after ACA coverage expansions, more work needed
Wednesday, March 29, 2017

State grades improve after ACA coverage expansions, more work needed

By Sarah E. Baumann, J.D.

Nearly all states improved across a variety of coverage indicators between 2013 and 2015, the time period in which a number of Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) coverage expansions were implemented. States that expanded Medicaid, in particular, saw significant improvements in categories including uninsurance rates among low-income working-age adults and low-income adults who went without care due to costs, according to the Commonwealth Fund’s (CWF’s) 2017 Scorecard on State Health System Performance. However, the rate of premature deaths before age 75 increased slightly for the first time in more than a decade and wide differences were noted between states.

Vermont was ranked top state overall, followed by Minnesota, Hawaii, Rhode Island, and Massachusetts, while Arkansas, Louisiana, Oklahoma, and Mississippi rounded out the bottom. Unfortunately, CWF noted large differences between states across measures. Performance measures in Vermont were an average of three times better than those in Mississippi. States that expanded Medicaid saw significant improvement in measures. Kentucky improved on more indicators—21—than any other state, regardless of expansion. The expansion state saw the biggest decline in uninsured working-age adults also saw the biggest percentage decrease of any state—seven points—in adults who said they went without care due to costs. Some expansion states also saw improvement in areas distinct from coverage, such as an increase in individuals up-to-date on vaccines.

States saw improvements in overall patient safety and quality issues. For example, the ACA Medicare hospital readmissions reduction program resulted in lower readmission rates in 33 states and the District of Columbia (D.C.), particularly among Kentucky, Illinois, and D.C. which originally had the highest rates. Fatal central line-associated bloodstream infections decreased in 20 states, and Medicare beneficiaries in 46 states were less likely be prescribed a high-risk medication that could be harmful in 2014, as compared to 2012.

CWF noted continued disparities for low-income individuals and ethnic minorities which were greater in lower-ranked states. For example, 34 percent of low-income adults in Texas reported skipping health care due to costs. As a result of plans to repeal the ACA, states may take on larger roles in drafting and implementing health policy, and CWF emphasized the need for states to improve overall health and patient care and address rising mortality rates.

Companies: Commonwealth Fund

IndustryNews: NewsStory NewsFeed AccessNews DrugNews GeneralNews HospitalReadmissionNews MedicaidExpansionNews MedicarePartANews PharmaServicesNews PreventiveCareNews QualityNews

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