August 31, 2016

Medicaid expansion works

This op-ed of mine ran in today's Gazette-Mail. I wonder if any trolls will bite...

Back in May 2013, Governor Tomblin announced his decision to expand Medicaid coverage for low income working adults. At the time, it was estimated that this would allow 91,500 previously uncovered people to gain coverage by this social insurance program.

The decision to expand Medicaid became a state option after a 2012 US Supreme Court decision upholding the Affordable Care Act (ACA). As of now, 32 states including the District of Columbia have decided to expand, while 19 have yet to do so.

Nobody guessed at the time that in just a couple years around 175,000 West Virginians would benefit—or that the WV Department of Health and Human Resources would do such a great job of signing up eligible people.

It’s one thing to measure increases in coverage, but it’s quite another to measure whether better health practices and outcomes result. This was especially true since such data emerges over time and the program was only launched in Jan. 2014.

After more than two years, a picture is emerging.

A study recently published in the Journal of the American Medical Association compared changes in health care for three states—Kentucky, Arkansas and Texas--since expansion became an option. Of these, Kentucky and Arkansas expanded Medicaid, with the former using the public program and the latter using private insurance. Texas did not choose to expand.

Obviously, the number of uninsured dropped dramatically in the first two states compared with Texas, which is what one would expect. The percentage rate went from 41.8 to 24.2 in Arkansas and from 40.2 to 8.6 in Kentucky. The changes were much smaller in Texas, where the rate dropped from 38.5 to 31.8, with the reduction largely due to the creation of insurance exchanges under the ACA.

There weren’t huge differences between Kentucky and Arkansas, although the former seemed to be doing a better job of managing diabetes. But things were different when these states were compared with Texas.

For one thing, eligible people in the two states that expanded care were 12.1 percentage points more likely to have a personal physician. Having a medical home is important to ensure continuous and comprehensive care.

They also experienced a 6.1 percentage point reduction in emergency room visits.

This is a big deal for more than one reason. For one thing, if you delay seeking medical treatment until it becomes an emergency, both health risks and costs increase. And, since hospitals are required to provide emergency services regardless of ability to pay, this can increase the cost of uncompensated care. And these costs tend to be passed on to others through higher premiums.

Medicaid expansion was also associated with fewer obstacles to care, such as out of pocket costs (-18.2 percentage points), skipping needed medications (-11.6 percentage points), and problems with bills (-14 percentage points).

People covered by the expansion were 16.1 percentage points more likely to receive medical checkups, which can mean more preventive care before things get out of hand. They were 12 percentage points more likely to receive regular care for chronic conditions. They were also 7.1 percentage points less likely to report receiving fair or poor care.

Best of all, the proportion of people claiming to be in excellent health in states that expanded Medicaid increased by 4.8 percentage points.

The report concluded that expansion resulted in “major improvements in access to primary care and medications, affordability of care, utilization of preventive services, care for chronic conditions, and self-reported quality of care and health.”

The study’s authors suggest that the data “provides support for staying the course” in states that have expanded Medicaid. And for the states that have yet to do so, expanding coverage “can produce substantial benefits for low-income populations.”

All these things together can make for healthier, longer, happier and more productive lives, in addition to boosting the state’s economy.

I’m glad West Virginia did the right thing. And I hope we hold the line in the future if these gains come under attack. People’s lives are riding on it.

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