Medicaid Expansion and Health: Assessing the Evidence After 5 Years

September 9, 2019 @ 3:26 pm

Heidi Allen and her coauthor examine the known impacts of the Affordable Care Act on the health of those in poverty and make the case for not drawing conclusions yet.

Recent studies published by Associate Professor Heidi Allen demonstrate the economic benefits that Medicaid can have for low-income families, from reducing evictions to diminishing the need for costly payday loans. However, studies showing Medicaid’s health benefits—a particular point of concern for policymakers debating expansion or retraction of the program—have been less definitive.

Part of the problem, write Allen and her colleague Benjamin Sommers of the Harvard T.H. Chan School of Public Health, in a new article for JAMA Viewpoints, is the fact that many positive health outcomes only occur long after insurance coverage is obtained. What’s more, a Medicaid expansion can change the characteristics of the pool of people seeking care, making it difficult to accurately compare data sets from before and after the expansion.

“This can lead to a faulty conclusion about the effect of the policy,” Allen and Sommers write, “because the populations present in the data set are fundamentally different than they would have been in the absence of Medicaid expansion.”

To help clarify Medicaid’s effects on health outcomes and guide policy discussions, the authors suggest focusing the debate around two primary questions:

  1. Is there early evidence of health improvements from those who gained coverage? In reviewing recent literature, the authors find that Medicaid has indeed improved some, but not all, health outcomes.
  2. Is Medicaid is the best way to improve outcomes for low-income populations, especially in comparison to private coverage? The authors issue the caveat that answers to this question warrant more research before drawing firm conclusions.

READ: “Medicaid Expansion and Health: Assessing the Evidence After 5 Years,” in JAMA Viewpoint (9.6.19)

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