By Tara Mancini
New research that appears in a Health Affairs “Web First” article finds that adults (ages 19-64) who are newly eligible for Medicaid under the ACA, and those who were previously eligible but not enrolled had similar or better health than pre-ACA enrollees. This is true for those in the income range that qualifies for Medicaid coverage under the ACA whether or not their state accepted the Medicaid expansion option or not. The authors concluded: “By electing to expand Medicaid eligibility, states could provide coverage to millions of healthier adults as well as to millions who have chronic conditions and who need care.”
Overall, newly eligible adults scored similarly on measures of general health to pre-ACA enrollees in both expansion and non-expansion states. In states already expanding, the newly eligible fared similarly on measures of general health, while in states not expanding, the newly eligible were slightly healthier than those already enrolled. In both groups of states, the newly eligible had lower rates of obesity, active asthma, and diabetes than pre-ACA enrollees, and were less likely to have one or more chronic condition, according to the study.
In states that are not expanding Medicaid, the newly eligible had higher mean scores for physical and mental health (i.e. categorized as being in better health) than pre-ACA enrollees and had lower rates for 5 (active asthma, diabetes, heart disease, high blood pressure, and obesity) of the 8 chronic conditions.
The data can be useful to all states in planning for the need of health services. However, the authors note that it might have bigger implications for uncompensated care in the states not expanding Medicaid. In those states, more than half of the estimated 5.7 million who lacked employer-sponsored health insurance and have income too low to participate in the marketplace also have at least one chronic condition.
The findings from Hill et al. are similar to those from two other recent studies (Decker et al., and Holahan et al.), although Hill et al. observe smaller differences in health between pre-ACA enrollees and the newly eligible. The authors attribute this difference to excluding disabled enrollees (in contrast to Decker et al.) and narrowing their measurement of chronic conditions to the prevalence of diagnosis rather than prevalence of treatment (in contrast to Holahan et al.).
