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Study: Medicaid expansion doesn’t affect care access, ED use

Tuesday April 8, 2014
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Previous expansions in Medicaid eligibility by states were not associated with an erosion of perceived access to care or an increase in ED use, according to a study.

In January, the Affordable Care Act expanded Medicaid eligibility so coverage in the public insurance program could be offered to more low-income Americans. However, some analysts have suggested that the demand for medical services created by Medicaid expansion may erode access to care for individuals already enrolled in Medicaid, which can be restrictive.

Chima D. Ndumele, PhD, of the Yale School of Public Health, New Haven, Conn., and the Brown University School of Public Health, Providence, R.I., and colleagues examined previous Medicaid expansions to gauge self-reported perceptions of access to care and the use of ED services by enrollees.

The authors examined data from 1,714 adult Medicaid enrollees in 10 states that expanded Medicaid between June 2000 and October 2009, and from 5,097 Medicaid enrollees in 14 bordering states that did not expand Medicaid.

In Medicaid expansion states, the proportion of Medicaid enrollees reporting poor access to care declined from 8.5% before the expansion to 7.3% after the expansion. In the control states where Medicaid was not expanded, enrollees reporting poor access to care remained constant at 5.3%.

The proportion of Medicaid enrollees reporting ED use decreased from 41.2% to 40.1% in expansion states and from 37.3% to 36.1% in states that did not expand Medicaid.

“We found no evidence that expanding the number of individuals eligible for Medicaid coverage eroded perceived access to care or increased the use of emergency services among adult Medicaid enrollees,” the authors wrote.

In a related editorial, Mitchell H. Katz, MD, director of the Los Angeles County Department of Health Services and a deputy editor of JAMA Internal Medicine, wrote:

“The Congressional Budget Office estimates that by 2022 there will be 12 million new enrollees into Medicaid. Although this is an unprecedented leap forward in providing low-income Americans with health insurance, it is important to remember that health insurance is not healthcare. Health insurance is a financial mechanism for paying for healthcare. It is not the care itself, or even a guarantee of care.

“The gap between health insurance and healthcare can be particularly challenging for many Medicaid recipients to bridge. Studies have shown that a substantial proportion of physicians do not accept new Medicaid patients.

“Therefore, amid the optimism that millions of previously uninsured persons will gain Medicaid coverage, there is a fear that the newly insured will not be able to find physicians who will care for them, or that the influx of new enrollees will make access harder for those persons who already have Medicaid.

"In this vein, the results of the study by Ndumele et al in this issue of JAMA Internal Medicine are reassuring.”

Study abstract: http://archinte.jamanetwork.com/article.aspx?articleid=1857094


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