Study: More Patients Are Insured, Use Health Care When States Expand Medicaid

Indianapolis health researchers hope the results of a new study will encourage policymakers to support nationwide Medicaid expansion.

Medicaid, a government-provided free health insurance program, is for low-income adults, those with disabilities who cannot work and others who meet specific criteria. Under the Affordable Care Act, states also have the right to expand Medicaid based on income alone, providing health insurance to anyone with an income at or below 138 percent of the federal poverty level.

Washington, D.C., and 32 states, including Indiana, Illinois, Missouri and Ohio, have opted to expand Medicaid. In a study published in the June issue of the journal Health Affairs, four Indiana researchers reviewed the published research on the impact of Medicaid expansion.

The study's authors wanted to determine if the research supported the goals of the Affordable Care Act, including more coverage, lower costs, better access to care and better patient outcomes.

"We weren't trying to determine how people like or dislike expansion, but really what's the scientific evidence on the impact of expansion," said Nir Menachemi, one of the researchers and an assistant professor at Indiana University-Purdue University Indianapolis. "We basically found that Medicaid expansion appears to be associated with an increase in coverage, with an increase in health service utilization and, to some degree, an increase in the quality of care."

Menachemi and co-authors Olena Mazurenko and Aaron Carroll, all professors at Indiana University, and IU doctoral student Casey Balio found states with expanded Medicaid had more insured residents. These insured patients were more likely to have their own physician. They were also likely to go to preventative doctors' appointments and not use the emergency department for regular care.

Menachemi said other studies have shown that preventative care improves a patient's ability to manage chronic illness like diabetes.

It was harder to demonstrate evidence of increased quality of care, Menachemi said. There isn't a definition of quality or a way it can be measured directly.

But Menachemi said quality of care indicators did improve within the body of research. Fewer patients died after surgery, more men were screened for prostate cancer and more women were given Pap tests, hospitalizations decreased and hospital stays were shorter.

Many of the studies showing the negative effects of Medicaid expansion couldn't show direct relationships between expansion and those issues, the researchers found.

"In just a short three or four years we've been able to amass a lot of evidence that suggests very promising results," Menachemi said. "When we wait a little bit longer, we'll have a better and increasingly robust picture of what's happening."

Medicaid expansion is still debated in legislatures across the country. Virginia lawmakers voted in May to expand that state’s Medicaid program next year, which would make it the 33rd state to do so. While more research is needed, Menachemi said this review can help lawmakers see trends in care.

"The better synthesized information we have that pulls together a nice overview of what's happening, the better it is for policy makers wanting to know what do we really know?" Menachemi said. "What does the science in this area tell us about the effects of policy decisions?"