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Studies Show Medicaid Expansion Is Improving Health, While Jury Still Out on Chronic Disease

Mary Caffrey
A batch of studies appearing in recent months have linked Medicaid expansion with lower death rates in renal failure, more efforts to quit smoking, and earlier detection of cancer. There are mixed outcomes in chronic disease, but an important clinical trial in Oregon shows that over the long haul, Medicaid expansion makes a difference.
As recently as March, when the Kaiser Family Foundation issued a policy brief on Medicaid expansion, authors wrote that it was too early to say whether extending coverage to another tier of low-income families would do more than improve access. Would coverage translate into better health?

In the second half of 2018, a new batch of studies shows that successes of Medicaid expansion are starting to emerge. Results of studies involving chronic disease are mixed so far, but some findings suggest the value of treating patients with diabetes and hypertension will pay off down the road, as this population ages.

A major study published in August found that Medicaid expansion has made it easier to catch cancer early, and this is helping to shrink disparities. Studies published in recent months have found connections between Medicaid expansion and efforts to quit smoking and lower death rates from renal failure.

These results combine with those of an earlier study from 2017, included in the Kaiser report, which found that Medicaid patients who received cardiac surgery in Michigan, an expansion state, had fewer postoperative problems than those from Virginia, which had not expanded Medicaid.

Unlike Medicare, the healthcare program for seniors funded entirely by the federal government, Medicaid is jointly funded by the federal government and the states, and the eligibility rules for the program for those with low incomes and the disabled vary greatly.

Under the Affordable Care Act, Medicaid expansion sought to extend coverage to families earning up to 138% of the federal poverty line, but the Supreme Court allowed states to decide whether to extend coverage. The 2010 law provided incentives for states to expand Medicaid starting in January 2014, and even today the federal government pays most of the cost of adding this new group to the rolls. Through the first 2 years of expansion, about 10.7 million newly eligible people signed up, as well as 3.4 million who had been eligible but had never enrolled.

To be sure, as the number of states without Medicaid expansion dwindles to just 14, following successful ballot measures in Nebraska, Idaho, and Utah, expansion is more palatable to conservative states than it was under the Obama administration. CMS leaders in the Trump administration allow states to impose work rules and just announced the terms of 1332 waivers that seem designed to give conservative states maximum flexibility (although some measures are being challenged by advocacy groups).

While there was no question that the first wave of expansion increased the number of people with access to health coverage—and stabilized finances at many safety net hospitals—the long-term goal of healthcare isn’t to send people to the doctor, but to keep them healthy. And some who question the merits of expansion have been waiting for that part of the equation to materialize.

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