Medicaid expansion produced negligible average effects on health and increased mortality rates across numerous age groups, according to a new report.
The report, “Is Medicaid Expansion Worth It,” published April 23, 2020 by the Texas Public Policy Foundation, is based on an analysis of a variety of studies on Medicaid expansion outcomes. Authors Brian Blase and David Balat sugges that targeted programs, including those particularly geared toward the young, provide more benefit to overall health than massive Medicaid expansion.
More than $300 billion, mostly from the federal government, was spent on Medicaid expansion between 2014 and 2018. In 2019, the federal government spent approximately $120 billion subsidizing health care coverage through Medicaid expansion and subsidies for coverage on the health insurance exchange.
Negative Impact on Mortality Rates
Since 2013, when the Affordable Care Act (ACA) was enacted, there has been a significant increase in Medicaid enrollment. However, as enrollment has increased, overall life expectancy rates decreased in states that expanded their Medicaid coverage relative to non-expansion states.
“The ACA significantly expanded health insurance coverage between 2013 and 2017, but Americans’ health worsened during this period as life expectancy declined for three consecutive years from 2014 to 2017,” Blase and Balat wrote.
Specifically, expansion states saw a difference in the percent increase in mortality of 1.5 percent versus non-expansion states, when measured in 2014. Mortality trends for non-elderly adults were also worse in Medicaid expansion states from 2013-2017.
Blase and Balat analyzed three economic studies released since 2018 that attempt to assess the effect of Medicaid expansion on mortality.
“One paper found that near-elderly individuals who had low income in the five-year period before the expansion took eﬀect had lower mortality rates after 2013 in expansion states,” Blase and Balat wrote. “A second paper found broader mortality reductions in Medicaid expansion states, but with the largest eﬀect also concentrated among 55- to 64-year-olds. However, a third paper found no discernible eﬀect of Medicaid expansion on mortality for the same age group and stresses the difficulty of drawing definitive conclusions from this type of research.”
However, Blase and Balat note that Medicaid expansion led to increases in preventive health services, access to primary care services, and fewer skipped medications due to cost. Furthermore, Medicaid expansion was associated with improvements in self-reported health and greater financial peace of mind. There has been mixed evidence on physical health benefits.
Better Options for Overall Health
In their report, Blase and Balat conclude that “programs that focus aid on providers that care for lower-income populations are almost certainly a better public investment than programs aimed at boosting coverage.”
States considering further expansion should consider the balance between medical services and social services. Blase and Balat note that Medicaid expansion increased the demand for medical services, including emergency room utilization, while there were not any corresponding measures or initiatives in the ACA for health care and other services that could provide greater benefits to low-income individuals.
“Ultimately, the enormous outlays of economic resources plowed into Medicaid expansion likely could have been used in a variety of ways to better improve the economic well-being and health of Americans,” Blase and Balat wrote.
Kelsey Hackem, J.D. (firstname.lastname@example.org) writes from Washington State.
Brian Blase, David Balat, “Is Medicaid Expansion Worth It?” The Texas Public Policy Foundation, April 2020: https://www.heartland.org/publications-resources/publications/is-medicaid-expansion-worth-it