Another piece of evidence that the Affordable Care Act’s expansion of health care insurance for the poor has been a major policy success:
A few recent studies suggest that people have become less likely to have medical debt or to postpone care because of cost. They are also more likely to have a regular doctor and to be getting preventive health services like vaccines and cancer screenings. A new study, published Monday in JAMA Internal Medicine, offers another way of looking at the issue. Low-income people in Arkansas and Kentucky, which expanded Medicaid insurance to everyone below a certain income threshold, appear to be healthier than their peers in Texas, which did not expand.
The study took advantage of what Dr. Benjamin Sommers, an author of the paper and an assistant professor of health policy and economics at Harvard, called “a huge natural experiment.”
In its 2012 ruling, the Supreme Court made the health law’s Medicaid expansion optional for states. The resulting variation in choices makes it much easier to compare what happened in different states and draw conclusions about what effects health insurance coverage might have for the finances and health of Americans.
The researchers gathered their results by conducting a large telephone survey of low-income residents of the three states. They asked the same questions three times: in 2013, before the law’s Medicaid expansion; at the end of 2014, after it had been in place for a year; and at the end of last year. Then they compared what happened over time, using Texas as a kind of control group to see how much of a difference the Medicaid expansions in the other two states made.
Their survey found people in Arkansas and Kentucky were nearly 5 percent more likely than their peers in Texas to say they were in excellent health in 2015. And that difference was bigger than it had been the year before.
There are differences between Arkansas and Kentucky as well. Kentucky expanded Medicaid in a more conventional way, while Arkansas tried an innovative expansion, offering its low-income residents private insurance. But the study found only small differences between the two approaches.
All things equal, it’s better to skip the middleman, but if allowing rentiers to make a buck is how you get a red state to expand Medicaid, you obviously do it.
Given the consequences of states refusing the Medicaid expansion, I’m wondering if Sebelius shouldn’t be #1 on this list.