The Impact of Medicaid Expansion on Health Care Access, Utilization, and Health

Under the Affordable Care Act (ACA), 32 states expanded Medicaid coverage to include adults with household incomes up to 138% of the Federal Poverty Level. Today, Medicaid remains a subject of intense state and federal budgetary and policy debates. To analyze the impact of the ACA’s Medicaid expansion on adults in poverty, I used national data from the 2011-2016 Behavioral Risk Factor Surveillance System to assess trends in health access, preventive service utilization, and health outcomes. I further stratified the analysis to investigate differential impacts on subpopulations including breakdowns by income, race, and age. As measured by rates of uninsurance, inability to afford doctor visits, and lacking a personal doctor, health care access improved significantly more in states that expanded Medicaid than those that did not. Medicaid expansion was associated with a 5.4% decrease in the uninsured rate and a 1.9% increase in the probability of having a routine checkup in the past 12 months. Whites and adults ages 55-64 experienced some of the greatest gains in health care access and routine checkup utilization. Health status improvement approached significance nationally but was significant among those in the $10,000-$14,999 income group. Medicaid expansion was also associated with increases in diagnoses of high blood pressure and high cholesterol. These findings indicate sustained improvements in access to care and evidence of changes in utilization and health that differ by population subgroups. Federal and state policymakers should weigh these benefits in considering Medicaid reforms and Medicaid expansion adoption.