by Carina Belles

As debates on the decision to expand Medicaid continue in Kansas, Missouri and Oklahoma, a new study in Health Affairs found that Medicaid expansion improved health outcomes in southern U.S. states, causing fewer self-reported declines in health status among low-income residents. This is the latest addition to a body of research that suggests Medicaid expansion has improved health outcomes in vulnerable populations. Researchers studied about 15,000 people, the majority of whom received most of their health care from community health centers in 12 southern states. The states that have yet to expand Medicaid as of 2020 are largely concentrated in the South (see map below), where legislators have held the position that the existing safety net provides adequate support for low-income Americans. This new research refutes that position, however. During the study, subjects were polled about their health status both before and after Medicaid expansion, with researchers finding that among the expansion population, 7.6% more people reported an increase in Medicaid coverage, and 1.8% fewer people reported a decline in their own health status compared to the non-expansion population. Citing this slower decline, researchers ultimately concluded that safety-net access is not an adequate substitute for insurance, and that states could “improve the health of their low-income residents by accepting expansion funds or otherwise extending coverage to low-income residents.” See a summary of the findings in the graphics below, plus the researchers’ state rankings regarding declining health.

*Researchers ranked the 12 selected states based on how their subjects’ self-reported health status changed from the pre-expansion to expansion time period.

NOTES: The 12 states selected by researchers were Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and West Virginia. During the study, which ran between 2008 and 2013, and again between 2015 and 2017, four states (Arkansas, Kentucky, Louisiana and West Virginia) expanded Medicaid. Researchers categorized those states as expansion states. Virginia is included in the study as a non-expansion state, as its Medicaid expansion did not take effect until 2019.

SOURCE: DHP, AIS’s Directory of Health Plans; Medicaid Expansion Slowed Rates of Health Decline for Low-Income Adults in Southern States, Health Affairs, January 2020. View the study here: http://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2019.00929.