A nonprofit publication of the Kentucky Center for Public Service Journalism

Low-income adults in Medicaid expansion in Kentucky, Arkansas report better health, care

By Melissa Patrick
Kentucky Health News

Two states that expanded Medicaid through the Patient Protection and Affordable Care Act showed a 41 percent increase in the number of enrollees with a regular health-care provider and a 23 percent increase in the share who report excellent health, according to a three-year study of Kentucky and Arkansas.

The study also found that low-income adults with chronic diseases in the two states were more likely to report that they had better health, were getting regular care and were able to afford their medications.

Kentucky and Arkansas and Kentucky both expanded Medicaid to people who earn up to 138 percent of the federal poverty line, but in different ways. Kentucky expanded Medicaid while Arkansas used federal Medicaid funding to provide private insurance to its low-income adults. The study compared them to Texas, which did not expand the program.

The report said that while Arkansas and Kentucky took different approaches to Medicaid expansion, the benefits to enrollees were nearly equal between the states.

“The Affordable Care Act is leading to substantial improvements in health care for low-income adults in Arkansas and Kentucky, and people report that their health is better too,” Dr. Benjamin Sommers, lead author of the study, said in a news release. “In contrast, many low-income adults in Texas continue to lack insurance and more frequently have to skip needed health care due to cost concerns.”

The study, published in Health Affairs, found that when compared to Texas, enrollees in Kentucky and Arkansas reported “substantially” better health, fewer emergency-room visits, increased access to care and medications, and cost savings.

Kentucky has 1.4 million people on Medicaid, with 470,000 of them covered through the expansion. As of Jan. 1, Arkansas had 310,951 low-income people enrolled on its “private option” plan funded by Medicaid.

Not surprisingly, low-income adults in Arkansas and Kentucky were much more likely to have health coverage than their counterparts in Texas.

Researchers found that by the end of 2016, the percentage of people in Arkansas and Kentucky without coverage had dropped 20 percentage points more than in Texas. In 2016, the uninsured rates were 7.4 percent in Kentucky, 11.7 percent in Arkansas, and 28.2 percent in Texas.

The study found that low-income adults who had gained coverage in Arkansas and Kentucky under the ACA had:

— A 41-percentage-point increase in having a usual source of health care
— A 58.6-point drop in reports of trouble paying medical bills
— A 74.7-point decline in skipping needed health care because of costs
— A 28-point drop in the likelihood of having an emergency-room visit
— A 23-point increase in the share who reported they were in excellent health
— $337 less in medical out-of-pocket spending per year

It found similar results among low-income adults with chronic illnesses who had gained coverage under the ACA, including:

— 56 percentage points more likely to report having regular care for their chronic condition than were chronically ill adults in Texas
— 51 points less likely than those in Texas to skip medications due to cost
— 20 points more likely to report being in excellent health

The study was conducted by the Harvard T.H. Chan School of Public Health. It surveyed a random sample of 10,885 adults aged 19 to 64 in November and December from 2013 to 2016 via land lines and cell phones. The study includes a demographic breakdown of the full samples in each state.

“This study, along with others, makes it clear that the Affordable Care Act’s Medicaid expansion has helped states make substantial gains in coverage while ensuring people can get and afford the health care they need,” said Dr. David Blumenthal, president of The Commonwealth Fund, which funded the study. “Repeal efforts that end the expansion threaten the health and financial security of the 12 million people nationwide who benefited from it. We must hold on to these gains and continue to work toward affordable and accessible health care for everyone.”

The House-passed health bill, called the American Health Care Act, would largely phase out the Medicaid expansion and limit federal funding of the program, reducing federal spending on it by an estimated 24 percent over 10 years. If people enrolled in the expansion went off it, they could not get back on. About 30,000 Kentuckians a month go on and off Medicaid.

Gov. Matt Bevin has said Kentucky can’t afford to pay for its share of the expansion costs (5 percent this year, rising to the ACA’s 10 percent limit in 2020) and has applied for a waiver that would let the state charge small, income-based premiums and would require “able-bodied” recipients to either work, volunteer, go to class or take job training, among other things.

The waiver request estimates that the changes would make the state’s Medicaid rolls have 86,000 fewer people in five years than without the waiver. The waiver is expected to be approved in June and to go into effect Jan. 1.

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