The Effects Of Medicaid Expansion Under The ACA: A Systematic Review

Abstract

Expanding eligibility for Medicaid was a central goal of the Affordable Care Act (ACA), which continues to be debated and discussed at the state and federal levels as further reforms are considered. In an effort to provide a synthesis of the available research, we systematically reviewed the peer-reviewed scientific literature on the effects of Medicaid expansion on the original goals of the ACA. After analyzing seventy-seven published studies, we found that expansion was associated with increases in coverage, service use, quality of care, and Medicaid spending. Furthermore, very few studies reported that Medicaid expansion was associated with negative consequences, such as increased wait times for appointments-and those studies tended to use study designs not suited for determining cause and effect. Thus, there is evidence to document improvements in several areas of health care delivery following the ACA Medicaid expansion. We outline areas for future research that can further reduce current knowledge gaps.

Association of Medicaid Expansion Under the Affordable Care Act With Insurance Status, Cancer Stage, and Timely Treatment Among Patients With Breast, Colon, and Lung Cancer

“…However, if a surge in insured patients with cancer overwhelmed an already strained oncology workforce, lengthened wait times and costly treatment delays could result, as have occurred outside oncology. 2,6 Lending further support to this hypothesis, we uncovered a temporal association with lengthened time to treatment in both expansion and nonexpansion states. This paradoxical finding warrants further study and may reflect an increasingly strained oncology workforce in the face of growing cancer prevalence, increasing complexity of care, and looming workforce shortages.…”

Association of Arkansas’s section 1115 Medicaid waiver with health insurance coverage

“…Our finding is consistent with other studies that found Medicaid expansion is associated with improved access to care [6][7][10][11]. Evaluation of Medicaid waivers will continue to be important as states propose alternatives to conventional Medicaid policy [3,9].…”

“…Consistent with other studies examining the effect of the Affordable Care Act (ACA) on health insurance coverage, we used a differences-in-differences (DD) linear probability regression to compare the association of health insurance coverage rates in Arkansas compared to what these rates would have been if Arkansas had expanded Medicaid without the waiver [6]. The state of Arkansas was defined as the treatment group.…”

Current Prevalence of Major Cancer Risk Factors and Screening Test Use in the United States: Disparities by Education and Race/Ethnicity

“…Additionally, barriers to accessing healthcare hinders a variety of preventive services, including receipt of provider recommendations for smoking cessation in current smokers, weight loss in obese adults, as well as vaccination and screening (12,42,(126)(127)(128). The most recent policy to address barriers to healthcare is the 2010 Affordable Care Act (ACA), which has led to gains in health insurance and the use of some preventive services by expanding dependent insurance coverage, subsidizing insurance through the federal marketplace for individuals with low and medium incomes (100%-400% of the federal poverty levels), expanding Medicaid eligibility to low-income adults in some states, and removing the cost of some preventive services for privately and Medicare insured adults (129)(130)(131)(132)(133). However, 14 states have not expanded Medicaid eligibility, and these states have a disproportionate number of lower socioeconomic and racial/ ethnic minorities ( Supplementary Table S8).…”