Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance

From the report published by the Commonwealth Fund:

Medicaid expansion under the Affordable Care Act has led to well-documented gains in coverage in many states, but less is known about how it has affected beneficiaries’ use of health care services and their health status. This Commonwealth Fund–supported study explored the impact on residents in three Southern states—each with high poverty rates and high baseline uninsured rates but differing responses to the Medicaid expansion.

Key Findings

  • Between 2013 and 2015, there were dramatic drops in the uninsured rates in both Arkansas (41.8% to 14.2%) and Kentucky (40.2% to 8.6%), but much smaller changes in Texas (38.5% to 31.8%).
  • In Arkansas and Kentucky, having coverage was associated with a significant increase in the likelihood of having a personal physician (12.1 percentage points) and a decreased reliance on the emergency department as a usual source of care (–6.1 points).
  • Expanded coverage also was associated with fewer delays obtaining care because of cost (–18.2 points), fewer skipped prescriptions (–11.6 points), and less difficulty paying medical bills (–14.0 points). Annual out-of-pocket medical spending dropped by 29.5 percent.
  • Expanded coverage in the two states also led to an increased likelihood of having a checkup (16.1 points) and a glucose check (6.3 points) in the past year. Diabetics had an increased likelihood of glucose monitoring (10.7 points).
  • Compared with Texas, the share of adults receiving regular care for chronic conditions increased 12.0 points, the share of adults reporting fair or poor quality of care declined 7.1 points, and the proportion reporting excellent health increased 4.8 points.
  • Arkansas’ coverage gains were primarily through private insurance, and Kentucky’s were through Medicaid. While changes in glucose monitoring were larger in Kentucky than in Arkansas, none of the other 26 outcomes differed significantly between the two states.

Read the full report from the Commonwealth Fund.

Download a PDF.