Expanding Medicaid through the Affordable Care Act (ACA) in 2014 is a key opportunity to improve the health and wellbeing of Kentuckians across the state, and Governor Beshear should be commended for his decision to embrace the expansion.
Our state faces tremendous health challenges—ranking close to the bottom among the states on many health indicators. By providing coverage for around half of the state’s uninsured (many of the remaining of whom will be covered by the ACA’s health insurance exchange), the Medicaid expansion will go a long way in helping to move the dial on Kentucky’s health status.
That’s because people who are uninsured have worse health outcomes than those with insurance—particularly those with chronic conditions like diabetes that Kentuckians suffer from at high rates. Study after study shows that lack of insurance is associated with increased rates of disease and earlier death.
The uninsured are less healthy because they are more likely to refrain from seeking medical care due to cost. A survey by the Kentucky Health Insurance Research Project showed that uninsured Kentuckians are more likely to delay medical attention; skip medical tests, treatments or follow-ups; fail to fill prescriptions for medicine; and avoid seeking out needed treatment from a specialist.
Market-based alternatives to Medicaid expansion that have been proposed by those in opposition to it tend to be either unrealistic in addressing the health needs of a low-income population or more expensive. For instance, the Cabinet for Health and Family Services reported that it could be 50 to 66 percent more expensive to implement the Arkansas model of providing vouchers to purchase private health insurance than it would be to provide traditional Medicaid.
In addition, those who misinterpret recent findings of the Oregon Health Study argue that Medicaid does not improve health, but the study’s findings actually support the claim that the Medicaid expansion improves the health and wellbeing of beneficiaries.
New findings from the study show that Medicaid beneficiaries were less likely than those without insurance to suffer from depression and more likely to be diagnosed with and treated for diabetes. Those with Medicaid were also far more likely to access preventive care such as mammograms for women. In addition, the Oregon study indicated that Medicaid very nearly eliminated catastrophic out-of-pocket health care costs, which are the cause of the majority of personal bankruptcies in the United States.
Earlier findings from the study include Medicaid recipients reporting that they were healthier than those who remained uninsured. Recipients were also more financially secure—less likely to avoid paying other bills because of high medical expenses and to have unpaid medical bills.
While the Oregon Health Study did not find significant changes in diagnoses or treatment of high blood pressure or high cholesterol from its small sample during an average of just 17 months on Medicaid, recipients’ increased use of preventive care could take years or even decades to show its full effect on health. Another recent study found that five years after three states expanded Medicaid, expansion was associated with a 6.1 percent reduction in mortality. Recipients were also more likely to report that their health was “excellent” or “very good” and less likely to report delaying care due to costs.
The Medicaid expansion not only makes good health and financial sense for individual Kentuckians—it also makes good economic sense for the state. The state’s Cabinet for Health and Family Services hired experts to perform independent studies of the cost of the expansion and its economic impact. The resulting report showed that Medicaid expansion in Kentucky will result in a net savings of $802 million to the state budget over the next eight years, and not expanding Medicaid would cost the state $39 million over that same period. The state saves money in part because expansion will cover some indigent health costs currently paid for through the state’s General Fund and create jobs that will generate additional tax revenues.
The Governor’s decision to accept the Medicaid expansion is a winner for Kentucky’s health and economy. Research shows that the expansion can improve health and wellbeing for beneficiaries and save the state money.