A study published in the January 2016 issue of Health Affairs, evaluated the impact of traditional Medicaid expansion versus the ‘private option’ of using Medicaid funds to purchase private insurance. To understand the impact of these interventions, researchers conducted telephone interviews — in November-December 2013 and twelve months later– with 5,665 low-income individuals from three states: Kentucky (traditional expansion), Arkansas (private option) and Texas (no expansion). Key findings included:
- The uninsured rate in Kentucky and Arkansas dropped 14 percentage points more than in Texas between 2013 and 2014.
- In 2013, the uninsured rate was about 40 percent in all three states. But by 2014, it had dropped to 19 percent in Arkansas and 12 percent in Kentucky, while falling to 27 percent in Texas. Even in nonexpansion states like Texas, the streamlined Medicaid application process and the publicity surrounding the ACA helped increase coverage among uninsured populations, the authors point out. Moreover, in all states, low-income people living between 100 percent and 138 percent of the federal poverty level are eligible for subsidies when buying coverage in the marketplaces.
- In Kentucky and Arkansas, the share of adults who said they were struggling to pay medical bills fell by nearly 9 percentage points more than in Texas. The share of those reporting not filling a prescription because of the cost fell nearly 10 percentage points more in the expansion states.
- Low-income adults in Kentucky experienced an even larger decline in medical bill problems compared with those in Arkansas, suggesting that Medicaid provides greater financial protection than private coverage, even with cost-sharing subsidies.
- The percentage of people visiting emergency departments (EDs) because they could not get a timely appointment in a physician’s office increased nearly 5 percentage points more in Kentucky and Arkansas compared with Texas. However, the share of adults in those two states reporting that the ED was their usual source of care dropped by 5 percentage points.
- Among adults with chronic illnesses like high blood pressure or diabetes, the share who reported receiving regular care for those conditions increased nearly 12 percentage points more in the expansion states than in Texas.
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Read a synopsis from the Commonwealth fund.