User login
Low-income adults living in two states that expanded Medicaid enrollment are showing significant increases in outpatient utilization and preventive care, improved health care quality, and reductions in emergency department use, compared with those living in a state that did not expand Medicaid, according to a new study.
The study also found similar improvements in care whether a state expanded traditional Medicaid or increased coverage through a private insurance option.
Benjamin D. Sommers, MD, PhD, of Harvard University, Boston, and his colleagues examined outcomes for nearly 9,000 low-income Medicaid enrollees in Kentucky (where officials expanded traditional Medicaid), Arkansas (where the state used funds to purchase private insurance to expand coverage), and Texas (which did not expand Medicaid) in November and December of 2013, 2014, and 2015. They looked specifically at changes in use of healthcare services, preventive care, and self-reported health (JAMA Intern Med. 2016 Aug 8. doi: 10.1001/jamainternmed.2016.4419).
“By the end of 2015, we found marked increases in coverage and reduced cost-related barriers to care in the expansion states, with associated increases in preventive care, outpatient visits, annual checkups, and chronic disease care, as well as decreased reliance on the [emergency department],” the researchers wrote.
They found that by 2015 there was a 6 percentage point drop in the likelihood of ED visits (P = 0.04), an increase of 0.69 office visits per person in the outpatient setting (P = 0.04), and an increase likelihood of getting a checkup (16.1 percentage points, P less than .001) in Medicaid expansion states. In Medicaid expansion states the share of adults obtaining regular care for chronic conditions increased by 12 percentage points after expansion (P = .008), compared with Texas. Additionally, adults reporting fair or poor quality of care dropped by 7.1 percentage points (P = .03).
One significant difference between the expansion states was changes in glucose monitoring rates for patients with diabetes were lower in Arkansas than Kentucky (–11.6 percentage points, P = .04).
“Of note, we found improvements in receipt of checkups, care for chronic conditions, and quality of care even in areas with primary care shortages, suggesting that while clinician capacity is undoubtedly an important consideration, insurance expansion can have a demonstrable positive impact even in areas with relative shortages, perhaps partially due to increased use of safety net providers,” the researchers added.
The study was supported by a research grant from the Commonwealth Fund and a grant from the Agency for Healthcare Research and Quality. The researchers reported having no financial disclosures.
Whether the premium assistance model proves to be durable and effective remains an open question. On the upside, the findings of Sommers et al suggest that the Arkansas initiative is living up to its promises. Moreover, the waiver seems to have increased the number of insurers participating in the marketplaces and contributed to lower premiums.
But other evidence concerning premium assistance waivers suggests the need for caution in assessing their effectiveness. The Government Accountability Office has questioned whether these waivers are budget neutral – a federal requirement. In this vein, the Congressional Budget Office has estimated that it will cost 50% more per enrollee to cover the expansion population on the exchanges than in the conventional Medicaid program. Nor are premium assistance waivers necessarily sustainable. In Pennsylvania, for instance, a newly elected Democratic governor worked to phase out that state’s existing alternative waiver, which had been negotiated by a prior Republican administration, in favor of a traditional expansion of the Medicaid entitlement.
Frank J. Thompson, PhD, and Joel C. Cantor, ScD, are both at Rutgers University in New Brunswick, N.J. They reported having no financial disclosures. Their comments were excerpted from a commentary in JAMA Internal Medicine (2016 Aug 8. doi: 10.1001/jamainternmed.2016.4422).
Whether the premium assistance model proves to be durable and effective remains an open question. On the upside, the findings of Sommers et al suggest that the Arkansas initiative is living up to its promises. Moreover, the waiver seems to have increased the number of insurers participating in the marketplaces and contributed to lower premiums.
But other evidence concerning premium assistance waivers suggests the need for caution in assessing their effectiveness. The Government Accountability Office has questioned whether these waivers are budget neutral – a federal requirement. In this vein, the Congressional Budget Office has estimated that it will cost 50% more per enrollee to cover the expansion population on the exchanges than in the conventional Medicaid program. Nor are premium assistance waivers necessarily sustainable. In Pennsylvania, for instance, a newly elected Democratic governor worked to phase out that state’s existing alternative waiver, which had been negotiated by a prior Republican administration, in favor of a traditional expansion of the Medicaid entitlement.
Frank J. Thompson, PhD, and Joel C. Cantor, ScD, are both at Rutgers University in New Brunswick, N.J. They reported having no financial disclosures. Their comments were excerpted from a commentary in JAMA Internal Medicine (2016 Aug 8. doi: 10.1001/jamainternmed.2016.4422).
Whether the premium assistance model proves to be durable and effective remains an open question. On the upside, the findings of Sommers et al suggest that the Arkansas initiative is living up to its promises. Moreover, the waiver seems to have increased the number of insurers participating in the marketplaces and contributed to lower premiums.
But other evidence concerning premium assistance waivers suggests the need for caution in assessing their effectiveness. The Government Accountability Office has questioned whether these waivers are budget neutral – a federal requirement. In this vein, the Congressional Budget Office has estimated that it will cost 50% more per enrollee to cover the expansion population on the exchanges than in the conventional Medicaid program. Nor are premium assistance waivers necessarily sustainable. In Pennsylvania, for instance, a newly elected Democratic governor worked to phase out that state’s existing alternative waiver, which had been negotiated by a prior Republican administration, in favor of a traditional expansion of the Medicaid entitlement.
Frank J. Thompson, PhD, and Joel C. Cantor, ScD, are both at Rutgers University in New Brunswick, N.J. They reported having no financial disclosures. Their comments were excerpted from a commentary in JAMA Internal Medicine (2016 Aug 8. doi: 10.1001/jamainternmed.2016.4422).
Low-income adults living in two states that expanded Medicaid enrollment are showing significant increases in outpatient utilization and preventive care, improved health care quality, and reductions in emergency department use, compared with those living in a state that did not expand Medicaid, according to a new study.
The study also found similar improvements in care whether a state expanded traditional Medicaid or increased coverage through a private insurance option.
Benjamin D. Sommers, MD, PhD, of Harvard University, Boston, and his colleagues examined outcomes for nearly 9,000 low-income Medicaid enrollees in Kentucky (where officials expanded traditional Medicaid), Arkansas (where the state used funds to purchase private insurance to expand coverage), and Texas (which did not expand Medicaid) in November and December of 2013, 2014, and 2015. They looked specifically at changes in use of healthcare services, preventive care, and self-reported health (JAMA Intern Med. 2016 Aug 8. doi: 10.1001/jamainternmed.2016.4419).
“By the end of 2015, we found marked increases in coverage and reduced cost-related barriers to care in the expansion states, with associated increases in preventive care, outpatient visits, annual checkups, and chronic disease care, as well as decreased reliance on the [emergency department],” the researchers wrote.
They found that by 2015 there was a 6 percentage point drop in the likelihood of ED visits (P = 0.04), an increase of 0.69 office visits per person in the outpatient setting (P = 0.04), and an increase likelihood of getting a checkup (16.1 percentage points, P less than .001) in Medicaid expansion states. In Medicaid expansion states the share of adults obtaining regular care for chronic conditions increased by 12 percentage points after expansion (P = .008), compared with Texas. Additionally, adults reporting fair or poor quality of care dropped by 7.1 percentage points (P = .03).
One significant difference between the expansion states was changes in glucose monitoring rates for patients with diabetes were lower in Arkansas than Kentucky (–11.6 percentage points, P = .04).
“Of note, we found improvements in receipt of checkups, care for chronic conditions, and quality of care even in areas with primary care shortages, suggesting that while clinician capacity is undoubtedly an important consideration, insurance expansion can have a demonstrable positive impact even in areas with relative shortages, perhaps partially due to increased use of safety net providers,” the researchers added.
The study was supported by a research grant from the Commonwealth Fund and a grant from the Agency for Healthcare Research and Quality. The researchers reported having no financial disclosures.
Low-income adults living in two states that expanded Medicaid enrollment are showing significant increases in outpatient utilization and preventive care, improved health care quality, and reductions in emergency department use, compared with those living in a state that did not expand Medicaid, according to a new study.
The study also found similar improvements in care whether a state expanded traditional Medicaid or increased coverage through a private insurance option.
Benjamin D. Sommers, MD, PhD, of Harvard University, Boston, and his colleagues examined outcomes for nearly 9,000 low-income Medicaid enrollees in Kentucky (where officials expanded traditional Medicaid), Arkansas (where the state used funds to purchase private insurance to expand coverage), and Texas (which did not expand Medicaid) in November and December of 2013, 2014, and 2015. They looked specifically at changes in use of healthcare services, preventive care, and self-reported health (JAMA Intern Med. 2016 Aug 8. doi: 10.1001/jamainternmed.2016.4419).
“By the end of 2015, we found marked increases in coverage and reduced cost-related barriers to care in the expansion states, with associated increases in preventive care, outpatient visits, annual checkups, and chronic disease care, as well as decreased reliance on the [emergency department],” the researchers wrote.
They found that by 2015 there was a 6 percentage point drop in the likelihood of ED visits (P = 0.04), an increase of 0.69 office visits per person in the outpatient setting (P = 0.04), and an increase likelihood of getting a checkup (16.1 percentage points, P less than .001) in Medicaid expansion states. In Medicaid expansion states the share of adults obtaining regular care for chronic conditions increased by 12 percentage points after expansion (P = .008), compared with Texas. Additionally, adults reporting fair or poor quality of care dropped by 7.1 percentage points (P = .03).
One significant difference between the expansion states was changes in glucose monitoring rates for patients with diabetes were lower in Arkansas than Kentucky (–11.6 percentage points, P = .04).
“Of note, we found improvements in receipt of checkups, care for chronic conditions, and quality of care even in areas with primary care shortages, suggesting that while clinician capacity is undoubtedly an important consideration, insurance expansion can have a demonstrable positive impact even in areas with relative shortages, perhaps partially due to increased use of safety net providers,” the researchers added.
The study was supported by a research grant from the Commonwealth Fund and a grant from the Agency for Healthcare Research and Quality. The researchers reported having no financial disclosures.
FROM JAMA INTERNAL MEDICINE
Key clinical point: Medicaid expansion improved self-reported health outcomes and access to care.
Major finding: By 2015 there was a 6 percentage point drop in the likelihood of emergency department visits (P = .04) and an increase of 0.69 outpatient office visits per person (P = .04).
Data source: A differences-in-differences analysis of survey data from Nov. 2013 through Dec. 2015 of 8,676 low-income adults in Kentucky, Arkansas, and Texas.
Disclosures: The study was supported by a research grant from the Commonwealth Fund and a grant from the Agency for Healthcare Research and Quality. The researchers reported having no financial disclosures.
