Rural Health Policy Project

Research: Coverage and Medicaid Expansion Effects on Parents and Children

Comprehensive Overview of Multiple Studies

The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review 1

A 2017 update of the broadest review currently published, this comprehensive look at 153 studies comparing Medicaid expansion and non-expansion states finds dramatic differences based on state Medicaid expansion decisions including huge reductions in uncompensated care delivered by safety net providers, dramatic increases in coverage and access, substantial increases in family financial security (which is, after all, a key role of having any kind of insurance) and multiple other areas.

Uninsured Children Get Covered when States Expand Medicaid for Adults

Medicaid Expansion For Adults Had Measurable ‘Welcome Mat’ Effects On Their Children 2

New eligibility for adults (including parents) under the Affordable Care Act meant over 700,000 children gained health coverage nationwide. This effect was largest when parents got Medicaid coverage in the 32 states (and DC) where Medicaid was expanded.  If the remaining 19 non-expansion states expanded Medicaid, 200,000 additional children would gain health coverage through existing programs.

Health Coverage for Parents and Caregivers Helps Children 3

When parents get health coverage they are more likely to sign up their children for health coverage: “States that extended Medicaid coverage to more uninsured adults saw nearly double the rate of decline in uninsured children as compared to states that didn’t accept the ACA’s Medicaid option.”

Children’s Health Insurance Rates in 2014: ACA Results in Significant Improvements 4

When Medicaid is Expanded to Parents, Regular Well Child Visits Increase for their Children

Spillover Effects of Adult Medicaid Expansions on Children’s Use of Preventive Services 5

This study found that expanding Medicaid to parents means kids from low-income families are more likely to get well-child care. The authors looked at a 12 year period from 2001-2013 and studied states that expanded Medicaid to parents during that time (these expansions were possible before the enactment of the Affordable Care Act). Possible reasons included having parents in the health care system and interacting with health professionals meant parents became more familiar with the benefits of getting their children regular well-child visits.

Parents and other Adults Gain Coverage at Higher Rates in Medicaid Expansion States

A Look at Early ACA Implementation: State and National Medicaid Patterns for Adults in 2014 6

The broadest look yet at gains in access to care comparing expansion and non-expansion states. According to the authors: “Uninsurance among both parents and childless adults fell sharply between 2013 and 2014, especially in states expanding Medicaid under the ACA.” In fact, Medicaid expansion states are nine of the ten states with the lowest uninsured rates for parents and non-expansion states are eight of the 10 states with the highest uninsured parent rate. Of special note, many parents of younger children, especially in the South, are currently eligible for Medicaid but not enrolled in the program.

Changes in Self-reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act 7

The ACA’s first 2 open enrollment periods were associated with significantly improved trends in self-reported coverage, access to primary care and medications, affordability, and health. Low-income adults in states that expanded Medicaid reported significant gains in insurance coverage and access compared with adults in states that did not expand Medicaid.”

Significant Improvement Seen in Coverage, Affordability, and Health for Parents and other Adults in Medicaid Expansion States

Medicaid Expansion Increased Coverage, Improved Affordability, And Reduced Psychological Distress For Low-Income Parents 8

The authors: “We found that [for parents] eligibility expansions increased coverage, reduced problems paying medical bills, and reduced severe psychological distress.”

Three-Year Impacts Of The Affordable Care Act: Improved Medical Care And Health Among Low-Income Adults 9

This is an influential continuing comparison study. The authors: We assessed changes in health care use and self-reported health after three years of the ACA’s coverage expansion, using survey data collected from low-income adults through the end of 2016 in three states: Kentucky, which expanded Medicaid; Arkansas, which expanded private insurance to low-income adults using the federal Marketplace; and Texas, which did not expand coverage….By the end of 2016 the uninsurance rate in the two expansion states had dropped by more than 20 percentage points relative to the nonexpansion state. For uninsured people gaining coverage, this change was associated with a 41-percentage-point increase in having a usual source of care, a $337 reduction in annual out-of-pocket spending, significant increases in preventive health visits and glucose testing, and a 23-percentage-point increase in “excellent” self-reported health. Among adults with chronic conditions, we found improvements in affordability of care, regular care for those conditions, medication adherence, and self-reported health.

Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance 10

The paper preceding the study described above. On multiple measures of access, use of health services and self-reported health, low-income adults are doing significantly better in Arkansas and Kentucky compared to Texas. One additional important finding from this study was the comparison it contained of the different types of Medicaid expansion in Arkansas (purchase marketplace plans) and Kentucky (expand existing program) showing almost identical improvements in both states.

Early Coverage, Access, Utilization, and Health Effects Associated With the Affordable Care Act Medicaid Expansions: A Quasi-experimental Study 11

Medicaid means gains in insurance coverage, more primary care, hospital care and more diagnosis of certain chronic diseases.

Injecting Facts Into the Heated Debates Over Medicaid Expansion 12

Editorial on the above study summarizes findings (and is not behind a paywall).

Medicaid Coverage Creates Long Term Health and Financial Benefits for Children and Families

The Affordable Care Act Medicaid Expansions and Personal Finance 13

The authors: “Results demonstrate financial improvements in states that expanded their Medicaid programs as measured by improved credit scores, reduced balances past due as a percent of total debt, reduced probability of a medical collection balance of $1,000 or more, reduced probability of having one or more recent medical bills go to collections, reduction in the probability of experiencing a new derogatory balance of any type, reduced probability of incurring a new derogatory balance equal to $1,000 or more, and a reduction in the probability of a new bankruptcy filing.”

Medicaid as an Investment in Children: What is the Long-Term Impact on Tax Receipts? 14

This Yale Economics study finds that long term effects on children of getting Medicaid coverage include greater tax contributions over time as they become adults, less likelihood of premature death, more likelihood of college attendance, and higher wages.

Uninsurance among Parents, 1997–2014: Long-Term Trends and Recent Patterns 15

“Parents who do not have coverage are less likely than insured parents to…see doctors and dentists and are more likely to forgo care for affordability reasons and have problems paying family medical bills. Uninsured parents’ disconnection from the health care system could have adverse spillover effects for children, who may be less likely to get needed health care and more likely to experience hardships if their parents’ health or finances deteriorate.”

Medicaid Covers a Larger Share of Adults and Children in Rural Areas; Expansions Increase Coverage More in Rural Areas

Medicaid in Small Towns and Rural America: A lifeline for Children, Families, and Communities 16

The authors: “Medicaid is a vital source of health coverage nationwide, but the program’s role is even more pronounced in small towns and rural areas. Medicaid covers a larger share of nonelderly adults and children in rural and small-town areas than in metropolitan areas; this trend is strongest among children.”

Medicaid Expansion Under the Affordable Care Act and Insurance Coverage in Rural and Urban Areas 17

The authors: “The Medicaid expansion increased the probability of having “any insurance” for the pooled urban and rural low-income populations, and it specifically increased Medicaid coverage more in rural versus urban populations.”

  1. Larisa Antonisse, Rachel Garfield, Robin Rudowitz and Samantha Artiga, Kaiser Family Foundation, Sep 25, 2017.
  2. J Hudson, A Moriya, Health Affairs, September 2017.
  3. Georgetown University, Center for Children and Families, March 2017.
  4. J Alker, A Chester, Georgetown University, Center for Children and Families, October 2015.
  5. Maya Venkataramani, Craig Evan Pollack, Eric T. Roberts, Pediatrics, November 2017.
  6. Genevieve M. Kenney, Jennifer M. Haley, Clare Wang Pan, Victoria Lynch, Matthew Buettgens,  September 8, 2016.
  7. B Sommers, MD, PhD Munira Z. Gunja, MPH; K Finegold, PhD; T Musco, BBA JAMA. 2015;314(4):366-374. doi:10.1001/jama.2015.8421.
  8. Stacey McMorrow, Jason Gates, Sharon K. Long, Genevieve M. Kenney, Health Affairs, May 2017.
  9. Benjamin D. Sommers, Bethany Maylone, Robert J. Blendon, E. John Orav, and Arnold M. Epstein, Health Affairs, June 2017
  10. Benjamin D. Sommers, Robert J. Blendon, E. John Orav, Arnold M. Epstein, Journal of the American Medical Association, August 8, 2016.
  11. Laura R. Wherry, Sarah Miller, Annals of Internal Medicine, June 21, 2016.
  12. Jeffrey T. Kullgren, Annals of Internal Medicine, June 21, 2016
  13. Medical Care Research and Review, Kyle J. Caswell, Timothy A. Waidman, September 16, 2017.
  14. David W. Brow, Amanda E. Kowalski, Ithai Z. Lurie, January 2015.
  15. Michael Karpman, Jason Gates, Stacey McMorrow, Genevieve M. Kenney, Urban Institute, June 27, 2016.
  16. Jack Hoadley, Karina Wagnerman, Joan Alker, Mark Holmes, Georgetown University and the University of North Carolina, June 6, 2017.
  17. Aparna Soni, Michael Hendryx, Kosali Simon, The Journal of Rural Health, January 2017.
Adam Searing is an Associate Professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.