The Effects of Medicaid Expansion under the ACA: Findings from a Literature Review

From the Issue Brief by Larisa Antonisse, Rachel Garfield, Robin Rudowitz and Samantha Artiga from the Kaiser Family Foundation:

Research on the effects of Medicaid expansions under the Affordable Care Act (ACA) can help increase understanding of how the ACA has impacted coverage; access to care, utilization, and health outcomes; and various economic outcomes, including state budgets, the payer mix for hospitals and clinics, and the employment and labor market. These findings may also inform ongoing debates surrounding the Medicaid expansion. This brief summarizes findings from 61 studies of the impact of state Medicaid expansions under the ACA. It includes peer-reviewed studies as well as free-standing reports, government reports, and white papers published by research and policy organizations between January 2014 and May 2016, using data from 2014 or later. The brief only includes studies that examine impacts of the Medicaid expansion; it excludes studies on impacts of ACA coverage expansions generally (not specific to Medicaid expansion alone) and studies investigating potential effects of expansion in states that have not (or had not, at the time of the study) expanded Medicaid. In both the brief and the appendix tables, findings are separated into three broad categories: Medicaid expansion’s impact on coverage; access to care, utilization, and health outcomes; and economic outcomes.

Key findings included:

  • Studies show that Medicaid expansion results in significant coverage gains.
  • Most research demonstrates that Medicaid expansion positively impacts access to care and utilization of health care services among the low-income population, but some studies have not identified significant effects in these areas and more research is needed to determine effects on health outcomes.
  • Analyses find positive effects of expansion on multiple economic outcomes, despite Medicaid enrollment growth initially exceeding projections in many states.

Read a summary of the Issue Brief.

Read the full Issue Brief.