The Impacts of the Medicaid Expansion: Arkansas, Kentucky and Texas

Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance,” Benjamin D. Sommers, Robert J. Blendon, E. John Orav, Arnold M. Epstein, JAMA Internal Medicine, online August 8, 2016, doi: 10.1001.jamainternmed.2016:4419


Ben Somers and colleagues compared changes under the ACA in Texas, Arkansas and Kentucky. The latter two adopted the Medicaid expansion under the ACA while Texas did not. The results between 2013 and 2015 were startling.

In Texas the uninsured rate for low income Texans fell from 39% to 32%. In Arkansas, it fell from over 40% to 14%; in Kentucky it fell from over 40% to 9%.

In the two expansion states, low-income residents saying they were in excellent health increased by 5% while those reporting they were in fair to poor health fell by 4.8%. These are remarkable results in only two years andpromising to build upon. Congratulations to the policy makers and providers who have made this possible after a time period when health outcomes for the white working poor in particular have been in peril due to rising inequality in incomes and treatments.

Coverage improved access to primary care by 12%, decreased ER use by 6%, reduced out of pocket spending by 30% and 12% fewer patient skipped their medications due to cost. Screening and treatment for diabetes, high cholesterol and high blood pressure all increased quite dramatically. This is what coverage is supposed to do.

In Texas, which did not expand Medicaid coverage, access to care worsened and financial distress of low income adults due to uncovered medical bills worsened between 2013 and 2015. Non-expansion states may begin to reassess their initial reluctance after the political season ends and a new President and Congress assume office.


Prepared by: Lucien Wulsin

Dated: August 9, 2016





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