Rural Health Policy Project

Research: Medicaid Expansions Help Parents, Children and Families Get Coverage, Afford Care, Reduce Debt

Recently Seema Verma, the Trump Administration’s director of Medicare and Medicaid, said that Medicaid provides “a card without care.” This line echoes state critics of Medicaid like Kentucky Governor Matt Bevin who recently said: “One of the most remarkable lies that has perpetrated in recent years in the healthcare community in America is that expanded Medicaid was working well in Kentucky.”

These statements and others like them ignore extensive research on the effectiveness of the Medicaid program overall and of the huge improvements in the lives of families driven by the Medicaid expansion in the states closing the coverage gap. While adults without children in the home certainly gained coverage, about one million parents with children in the home got coverage as a result of state Medicaid expansions. And extending coverage to parents means more kids are connected to coverage. Why? The “welcome mat” effect means when parents enroll in coverage, it’s more likely their children will be signed up for coverage too.  

In fact, a recent study in the respected journal Health Affairs found that extending Medicaid eligibility to more 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. And a new study in the journal Pediatrics found that when Medicaid is expanded to parents, children in low-income families were much more likely to get regular well-child visits – meaning covering parents directly resulted in better care for children.

We also know from research published by the Urban Institute that “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.” Extending Medicaid to adults means that more adults with young children in the home, as well as adults who do not have children, are more likely to be insured.

And if children and parents getting covered through the Medicaid expansion wasn’t enough, we know that there are major gains for these parents and other adults as they are more likely to have preventive health visits, more regular care for chronic conditions, reduced distress, and reduced problems paying medical bills. See these comprehensive research studies here and here.

Finally, we know that Medicaid is especially important in rural areas and small towns of our country. Our research has found that, “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.” And research published in The Journal of Rural Health this year found that “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.”

So, extensive research shows Medicaid expansion under the Affordable Care Act is especially critical to rural areas. It also shows Medicaid expansion has helped reduce the uninsured rate for parents (and their children) and leads to long term health and financial benefits for families. While Medicaid can always be improved, ignoring the significant research detailing all the benefits Medicaid brings to America’s families is shortsighted.

Download a short overview of research on Medicaid expansions with a focus on benefits to children and families and check out our interactive maps to see how important Medicaid is to your community.

Adam Searing is an Associate Professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.