New <em>Health Affairs</em>: Medicaid Expansion And Vulnerable Populations

Abstract

Health Affairs’ June issue, released today, examines the challenges and benefits for states deciding whether to embrace the law’s Medicaid expansion or opt out. Several studies in the issue also look at population disparities in health care, especially during the recent recession. Selected content in the issue is supported by grants from the New York State Health Foundation and Blue Shield of California Foundation. Medicaid Opt-out: What Cost to States? Last summer’s US Supreme Court ruling about the Affordable Care Act allows states to decline the law’s Medicaid expansion provision, something fourteen governors have chosen to do. Carter Price and Christine Eibner, both of the RAND Corporation, analyzed how this would affect coverage and spending. They estimate that in these states 3.6 million fewer people would be insured, and federal transfer payments to those states could fall by $8.4 billion. According to the authors, those states will be spending some $1 billion in the short term on uncompensated care. They conclude that in terms of coverage, costs, and federal payments, states and their citizens would fare better by expanding Medicaid coverage. In a related article, Thomas DeLeire of the University of Wisconsin and coauthors looked at Wisconsin’s four-year-old public insurance program—the BadgerCare Plus Core Plan—for childless adults with incomes of up to 200 percent of the federal poverty level. The authors compared administrative claims data from the first year of the program with the previous year. They found that program participants who were automatically enrolled in the program (and who tended to have very low incomes) showed a 29 percent increase in outpatient visits; a 46 percent increase in emergency department use; and a 59 percent decrease in hospitalizations, including a 46 percent decline for preventable hospitalizations. These results demonstrate that expanding public insurance coverage will increase access to outpatient care and reduce hospitalizations, but the authors caution that unless consumers have sufficient access to primary care, coverage expansions may also increase emergency department visits, shrinking any corresponding cost savings.