Expanding Medicaid has not affected healthcare access

Fears that expanding Medicaid eligibility under the Affordable Care Act will hamper access to care for those already in the program, and overwhelm emergency services, are largely unfounded, a new study led by the Yale School of Public Health has found. The study appears in the journal JAMA Internal Medicine.

Despite the size and scope of the Medicaid program — it was created in 1965 and today serves approximately 20% of the U.S. population — there is relatively little information on how changes in Medicaid eligibility affect access to primary care and the use of services. The study is believed to be one of the first to forecast the likely impact of Medicaid’s expansion on individuals with existing coverage.

Researchers studied enrollees in 10 states where Medicaid, which serves low-income families and individuals, has already expanded. They found that there was no detrimental effect on access to care for these previously enrolled Medicaid recipients. In fact, the proportion of enrollees reporting poor access to health care actually declined slightly, from 8.5% to 7.3%. They also studied enrollees in 14 states where eligibility requirements were unchanged. The proportion of people perceiving poor access remained constant at 5.3%.

In both states where Medicaid has expanded or remained unchanged, there appeared to be little effect on the use of emergency services as well — the proportion of enrollees using emergency department services decreased by 1%.

The Affordable Care Act is expected to further loosen Medicaid income eligibility requirements and extend coverage to several million more Americans beginning this year. This expansion, advocates claim, will improve access to health care and reduce the likelihood of preventable diseases.

“These results are particularly encouraging for current Medicaid enrollees. Our results indicate that covering more people is unlikely to significantly disrupt care for the people who were there previously,” said Chima D. Ndumele, assistant professor at the Yale School of Public Health and the paper’s lead author. “On the other hand, it’s clear that we must remain vigilant about connecting newly eligible Medicaid enrollees with the health care system.”

A number of provisions in the Affordable Care Act, including increasing reimbursement for providers and funding for community health centers, will be instrumental in ensuring continued access to physicians for individuals insured by Medicaid, the research noted.

Ndumele said that the study has implications for state policymakers planning or contemplating expanded Medicaid coverage.

Ndumele co-authored the paper with colleagues from the Brown University School of Public Health, the Providence VA Medical Center, the VA Boston Healthcare System, and the Boston University School of Public Health.

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