Association for Public Policy Analysis & Management

Panel: Impacts of Recent Changes to the Medicaid Program on Access to and Quality of Health Care

(Health Policy)

Studies of recent insurance expansions resulting from the Affordable Care Act (ACA) legislation provide unique opportunities to inform state and federal policymakers about the connections between insurance coverage and design and measures of access to and use of health care services. Among other provisions, the ACA expanded insurance coverage through the Marketplace and, in some states, expansions in Medicaid eligibility. The first paper compares changes in coverage and access to and use of health care for states that expanded Medicaid eligibility to all low-income adults compared to those which did not. It is the first paper to do this using nationally-representative federal survey data. In addition to changes in coverage, the paper finds that in 2014, the percentage of low-income adults who had seen a general practitioner or visited an emergency room increased 5.1 and 3.2 percentage points more in expansion compared to non-expansion states. Although Florida is not a state that expanded Medicaid in 2014, the state modified its existing Medicaid program by mandating enrollment in managed care. Using inpatient data through June 2015, the second paper finds that this change was associated with a 3.6% decline in preventable hospitalizations. The third paper finds that increases in Medicaid eligibility in expansion states affect over one-quarter of families with at least one Veteran that had previously spent more than 20% of their income on health care and premiums. The final paper responds to a concern about whether the current primary care workforce is sufficient to respond to increases in the demand for care brought about by the ACA. It does so by estimating changes in measures of access to care for individuals who were insured prior to ACA in areas which experienced large increases in insurance coverage compared to those that did not. The implications of this research for policy will be discussed by practitioners from MACPAC and CBO. The Medicaid and CHIP Payment and Access Commission (MACPAC) is a non-partisan legislative branch agency that makes recommendations to Congress, the Administration, and states on issues related to Medicaid and the State Children’s Health Insurance Program (CHIP). The Congressional Budget Office (CBO) produces independent analyses of budgetary and economic issues to support the Congressional budget process.