The Affordable Care Act – signed into law by President Barack Obama in March 2010 – called for an expansion of Medicaid, which projected insurance coverage for 16 million additional low-income Americans. But a June 2012 Supreme Court ruling modified this expansion, giving states the option of whether or not to expand Medicaid coverage. Now, a new study investigates what the people this expansion would affect think of Medicaid.
The study, conducted by researchers from the Harvard School of Public Health (HSPH) in Boston, MA, is published in the journal Health Affairs.
They note that under the Affordable Care Act (ACA), each state is allowed to choose whether or not to expand Medicaid to adults with incomes below 138% of the federal poverty level. Currently, 27 states and Washington, DC, have chosen to expand, while 23 states have not.
“In the debate over whether or not states should participate in Medicaid expansion, we rarely hear the perspectives of those people most directly impacted by policies surrounding Medicaid,” says study co-author Benjamin Sommers, assistant professor of health policy and economics at HSPH.
According to HealthCare.gov, if a state is expanding Medicaid, individuals who make up to $16,105 a year for one person (or $32,913 for a family of 4) will likely qualify for Medicaid coverage.
However, individuals with a limited income living in a state that opts to not expand Medicaid will not have many options for health coverage.
The researchers assessed how low-income adults felt about Medicaid in three Southern states that adopted different approaches to the expansion options:
- Kentucky, which opted for traditional Medicaid expansion
- Arkansas, which is expanding by using Medicaid dollars to buy private health insurance for low-income residents
- Texas, which is not expanding.
To conduct their study, the team carried out a telephone survey in late 2013 to 2,864 adults aged 19-64, living in those three states, who reported a household income of less than 138% of the federal poverty level.
The researchers note that we “know very little about views of the Medicaid expansion and the private option among those most directly affected by these major decisions: the low-income adults who would be potentially eligible for coverage. In health policy, their views are seldom heard.”
Results showed that in all three states, almost 80% of the participants said they supported Medicaid expansion, and around two thirds of uninsured adults planned to apply for either Medicaid or subsidized private coverage in 2014.
Additionally, nearly 75% of respondents rated Medicaid as equal to or better than private insurance in terms of quality of care. Among racial and ethnic minorities, people with lower education and income, and those in worse health, support for Medicaid was most common.
But the researchers note that the survey participants’ awareness of their individual state’s expansion plan was low.
There were some limitations to the study, which the researchers identify. For example, because they only focused on three states, this may limit generalizability.
However, they do note that they found a high level of support in the three Southern states, which are more conservative, on average, than the rest of the country. “If anything,” Sommers notes, “support for Medicaid expansion is likely to be even higher in many other states.”
Other limitations include response rates lower than those of government surveys – but similar to or better than those of random-digit-dial surveys, including the Gallup poll. And because all of the data were self-reported, it could be problematic for health status and clinical conditions, which could be influenced by health insurance status itself.
Still, the researchers note that their study shows the respondents have substantial medical needs and many financial barriers to care, so Medicaid expansion would greatly benefit them.
The team concludes:
“While state policy makers continue to debate the relative merits of whether and how to expand Medicaid under the ACA, our data indicate that there is little debate among most low-income adults that they would benefit from expanded coverage.”
Medical News Today recently reported on a study that suggested the ACA has improved insurance coverage for young adults. However, the study added that this increased coverage has not been linked with any significant changes in health status.