The Expansion of Medicaid Coverage under the ACA

Abstract

The expansion of Medicaid coverage under the Affordable Care Act offers the potential for significant increases in health care access, use, and spending for vulnerable nonelderly adults who are uninsured. Using pooled data from the Medical Expenditure Panel Survey, this study estimates the potential effects of Medicaid, controlling for individual and local community characteristics. Our findings project significant gains in health care access and use for uninsured adults who enroll in Medicaid coverage and have chronic health conditions and mental health conditions. With that increased use, annual per capita health care spending for those newly insured individuals (excluding out-of-pocket spending) is projected to grow from $2,677 to $6,370 in 2013 dollars, while their out-of-pocket spending would drop by $921. It is expected that these increases in spending would be offset at least in part by reductions in uncompensated care and charity care.

Prevalence and Medical Costs of Chronic Diseases Among Adult Medicaid Beneficiaries

“…Patients with severe mental disorders, such as schizophrenia or bipolar disorder, had high healthcare costs. 17 , 24 – 26 , 30 , 37 Clemans-Cope et al 17 found the average annual cost per patient with one or more mental disorders to be $11,120 (after summing the separately presented payer costs and out-of-pocket costs), well above the average they found of $9,273 per patient with one or more chronic conditions overall.…”

“…Of these, 29 original research articles 12 – 40 met the selection criteria ( Figure 1 ). Of these, 20 (69%) examined costs 13 , 17 , 20 – 26 , 29 – 37 , 39 , 40 and 19 (66%) examined prevalence 12 – 20 , 22 , 25 , 27 – 30 , 32 , 33 , 38 , 40 ; ten (34%) included both costs and prevalence. 13 , 17 , 20 , 22 , 25 , 29 , 30 , 32 , 33 , 40 Among the 29 studies, 17 (59%) examined diabetes; 16 (55%), mental disorders; 15 (52%), respiratory illnesses; 15 (52%), heart disease and stroke; 12 (41%), hypertension; 11 (38%), other chronic conditions; ten (34%), cancer; seven (24%), multiple chronic conditions; and six (21%), dyslipidemia.…”

“…Of the 20 studies exploring costs, 15 included a breakdown of costs by component (e.g., outpatient, pharmacy), 17 , 20 , 22 – 26 , 29 , 30 , 32 – 34 , 36 , 39 , 40 and one studied hospital costs only 37 ; the remaining four presented total cost without a breakdown of costs by component. Cost estimates varied widely for some diseases, which could partially be because of differences in studies’ definitions of included costs and the types of statistical analyses used.…”

“…23 , 33 One study estimated that the cost of a beneficiary with one or more chronic conditions was $8,881, plus $392 in out-of-pocket costs, and the costs per beneficiary with one or more mental disorders was $10,645, plus $475 in out-of-pocket costs. 17 …”

“… 14 , 18 , 27 , 47 Multiple studies compared the then-current (pre-expansion) Medicaid population to those potentially eligible under expansion and found then-current beneficiaries to be in similar or worse health, suggesting that expansion could shift the Medicaid population to be slightly healthier on average. 13 , 17 , 25 However, the extent of changes to the Medicaid population following the Affordable Care Act expansion also depends on the level of outreach and potential adverse selection. 14 , 18 , 27 , 48 – 51 The lack of use of post-2014 data in the reviewed studies is an evidence gap that should be filled with future research.…”