Health-Related Outcomes among the Poor: Medicaid Expansion vs. Non-Expansion States

INTRODUCTION States' decisions not to expand Medicaid under the Affordable Care Act (ACA) could potentially affect access to care and health status among their low-income residents. METHODS The 2010-2012 nationally representative Medical Expenditure Panel Survey data were analyzed in 2015 to compare 9755 low-income adults aged 18-64 years from Medicaid-expanding states with 7455 adults from nonexpanding states. Multivariate logistic regression models were fitted to evaluate the differences in access to care, receipt of preventive services, quality of care, attitudes about health and self-reported health status by Medicaid expansion status. The differences in care utilization and medical expenditures between the two groups were examined using a 2-part modeling approach. RESULTS Compared to their counterparts in Medicaid expansion states, low income adults in the nonexpanding states were more likely to be black and reside in rural areas and were less likely to have a usual source of care (prevalence ratio[PR] 0.86, 95% confidence interval[CI] 0.82-0.91) and recommended preventive services such as dental checkups (PR = 0.86; CI = 0.79-0.94), routine checks (PR = 0.89; CI = 0.83-0.95), flu vaccinations (PR = 0.89; CI = 0.81-0.98), and blood pressure checks (PR = 0.96; CI = 0.94-0.99). They also had less care utilization, fewer prescriptions, and less medical expenditures, but more out-of-pocket expenditures (all p-value <0.05). CONCLUSIONS Low-income adults in Medicaid nonexpanding states, who are disproportionately represented by blacks and rural residents, were worse off for multiple health-related outcomes compared to their counterparts in Medicaid expanding states at the baseline of ACA implementation, suggesting that low income adults residing in nonexpanding states may benefit markedly from the expansion of Medicaid.