State medicaid expansions did not erode perceived access to care or increase emergency services

Previous expansions in Medicaid eligibility by states were not associated with an erosion of perceived access to care or an increase in emergency department (ED) use.

In January 2014, the Patient Protection and Affordable Care Act (ACA) expanded Medicaid eligibility so coverage in the public insurance program could be offered to more low-income Americans. However, some have suggested that the demand for medical services created by Medicaid expansion may erode access to care for individuals already enrolled in Medicaid, which can be restrictive.

The authors examined previous Medicaid expansions to gauge self-reported perceptions of access to care and the use of ED services by enrollees. The authors examined data from 1,714 adult Medicaid enrollees in 10 states that expanded Medicaid between June 2000 and October 2009, and from 5,097 Medicaid enrollees in 14 bordering states that did not expand Medicaid.

In Medicaid expansion states, the proportion of Medicaid enrollees reporting poor access to care declined from 8.5 percent before the expansion to 7.3 percent after the expansion. In the control states where Medicaid was not expanded, enrollees reporting poor access to care remained constant at 5.3 percent. The proportion of Medicaid enrollees reporting use decreased from 41.2 percent to 40.1 percent in expansion states and from 37.3 percent to 36.1 percent in states that did not expand Medicaid.

"We found no evidence that expanding the number of individuals eligible for Medicaid coverage eroded perceived access to care or increased the use of emergency services among adult Medicaid enrollees," said Chima D. Ndumele, Ph.D., of the Yale School of Public Health, New Haven, Conn., and the Brown University School of Public Health, Providence, R.I., and colleagues in their JAMA Internal Medicine paper.

More information: JAMA Intern Med. Published online April 7, 2014. DOI: 10.1001/jamainternmed.2014.588

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Independent safety investigation needed in the NHS

1 hour ago

The NHS should follow the lead of aviation and other safety-critical industries and establish an independent safety investigation agency, according to a paper published today by the Journal of the Royal Society of Medicine. The au ...

Sexual fantasies: Are you normal?

5 hours ago

Hoping for sex with two women is common but fantasizing about golden showers is not. That's just one of the findings from a research project that scientifically defines sexual deviation for the first time ever. It was undertaken ...

AMA 'Code of Ethics' offers guidance for physicians

10 hours ago

(HealthDay)—The American Medical Association (AMA) Code of Ethics and other articles provide guidance for physicians in relation to public health emergencies, according to a report from the AMA.

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.