We know that states that expanded their Medicaid program have far fewer uninsured working-age adults. Now, thanks to a new study from the nonpartisan Government Accountability Office (GAO), we know that such health insurance coverage is leading to better access to care.
Data released by the U.S. Census Bureau in September showed that in 2017 the uninsured rate for 19-64 year olds in states that did not expand Medicaid eligibility was 16.7 percent, while the uninsured rate in states that did expand Medicaid was 9.4 percent. The new report from the GAO shows that low-income adults in expansion states are less like to report having unmet medical needs, are less likely to forego care because of cost, are more likely to have a usual place of care, and are more likely to receive selected health care services (like getting a flu shot or a blood pressure check) than their peers in states that did not expand Medicaid.
The GAO worked with the National Center for Health Statistics to analyze federal survey data from 2016. Among the report’s findings:
- The percentage of low-income adults who reported any unmet medical need was more than 50 percent higher in nonexpansion states compared to expansion states (40 percent in nonexpansion states vs. 26 percent in expansion states).
- Low-income adults in states that did not expand Medicaid were more than twice as likely to forgo medical care due to cost: roughly 20 percent of low-income adults in nonexpansion states reported they were forced to forgo needed medical care because they could not afford the service, compared to nine percent of low-income adults in expansion states. Twenty-two percent of low-income adults in nonexpansion states said they needed but could not afford dental care, compared to 15 percent in states that did expand Medicaid.
- Even low-income adults who were uninsured fared better in expansion states than their peers in nonexpansion states in many respects. They were less likely to report having unmet medical needs and less likely to report having to forego health care services because of cost than their counterparts in states that did not expand Medicaid.
The GAO report doesn’t say why it is that uninsured low-income adults have fewer unmet needs or financial barriers to care compared to folks in expansion states, despite not having insurance. One could speculate that states that chose to protect more low-income residents by expanding Medicaid eligibility are also more likely to provide more funding for community health centers or other sites for care, and/or that they are better at providing other services like food and shelter that allow people in need to spend their limited resources on needed medical care.
Sen. Ron Wyden (D-OR), who requested the study, said following the report’s release, “States around the country have an opportunity to expand Medicaid to more people – these findings help show why it’s a winning proposition for states and the millions of Americans currently left out of America’s health care system.”
These findings are similar to the positive results compiled by the Center on Budget and Policy Priorities, which found, for example, that while 32 percent of uninsured people reported having a medical problem but did not see a doctor, that was true of only 9 percent of Medicaid enrollees. Medicaid enrollees were also less likely to report medical debt or trouble paying medical bills. In addition, surveys in Medicaid expansion states Arkansas and Kentucky found increases in enrollees getting health check-ups (30 percent and 54 percent up, respectively). Arkansas’ recent denials of Medicaid to nearly 8,500 people who could not meet work reporting requirements would be expected to reduce the number of people overall receiving check-ups.
According to Families USA, residents of four states will be voting on Medicaid expansion via ballot initiatives this November. Residents in Utah, Idaho, and Nebraska will be voting on whether to expand their Medicaid programs, while voters in Montana will decide whether or not to continue their Medicaid expansion program, which is currently set to expire in 2019. The findings in the new reports should tell voters that Medicaid expansion will help more of their neighbors get medical care.