Two years after Arkansas and Kentucky expanded Medicaid, low-income adults in those states were more likely to have a primary-care doctor and receive care for their chronic conditions, and less likely to visit the emergency room, according to a study published in the American Medical Association's internal-medicine journal.
The study, published Monday, found that those improvements in health care were pronounced when compared with Texas, which did not expand Medicaid.
The study also found the improvements in Arkansas, which expanded Medicaid through private insurance plans under the so-called private option, were similar to those in Kentucky, which provides coverage through managed-care companies.
"After 2 years of coverage expansion in Kentucky and Arkansas, compared with Texas's nonexpansion, there were major improvements in access to primary care and medications, affordability of care, utilization of preventive services, care for chronic conditions, and self-reported quality of care and health," the study's authors wrote.
They added that the study provides support for "staying the course" in providing coverage under expanded Medicaid in Arkansas and Kentucky.
"For other states still considering whether to expand, our study suggests that coverage expansion under the [Patient Protection and Affordable Care Act] -- whether via Medicaid or private coverage -- can produce substantial benefits for low-income populations," the authors wrote.
Bo Ryall, chief executive of the Arkansas Hospital Association, said the study indicates that the private option is providing enrollees with an alternative to the emergency room by giving them access to primary-care doctors.
Joe Thompson, director of the Arkansas Center for Health Improvement, called the improvements in health care resulting from the expansions in Arkansas and Kentucky, compared with the lack of improvement in Texas, "dramatic" and said the study "documents the benefit and the value in insurance coverage."
Medicaid expansion was intended to be mandatory under the 2010 law but became optional after the U.S. Supreme Court in 2012 found the requirement to be unconstitutional.
The District of Columbia and 31 states had expanded Medicaid as of last month, according to the Menlo Park, Calif.-based Kaiser Family Foundation.
In Arkansas, the expansion provided coverage to more than 290,000 people as of April 30.
The study was conducted by researchers with the Harvard School of Public Health and Brigham and Women's Hospital in Boston. It was based on phone surveys in November and December of 2013, 2014 and 2015 of about 1,000 nonelderly adults in each state with household incomes below 138 percent of the poverty level.
In Arkansas and Kentucky, Medicaid expansion extended eligibility to adults with incomes below that level, which this year is $16,394 for an individual or $33,534 for a family of four.
In Texas, Medicaid coverage for nondisabled adults as of January 2016 was limited to parents with incomes below 18 percent of the poverty level, according to the Kaiser Family Foundation. Nondisabled, childless adults are not eligible for Medicaid in Texas.
Survey respondents were asked more than two dozen questions on topics such as their health and access to medical care.
In Arkansas, the survey found that the percentage of adults with incomes below 138 percent of the poverty level who lacked insurance fell from 41.8 percent in 2013 to 19.4 percent in 2014 and 14.2 percent in 2015.
The drop was even steeper in Kentucky, where the percentage of such adults who lacked insurance fell from 40.2 percent in 2013 to 12.4 percent in 2014 and 8.6 percent in 2015.
In Texas, the percentage fell from 38.5 percent in 2013 to 27.1 percent in 2014, then rose to 31.8 percent in 2015.
An earlier installment of the same survey, published in Health Affairs in January, found a drop from 2013 to 2014 in the percentage of low-income adults in Arkansas and Kentucky who had trouble paying medical bills or skipped a prescription because of the cost.
Those percentages continued to fall in 2015. The survey results from that year also indicated improvements in other areas, suggesting that "preliminary studies likely underestimate the longer-term impacts of Medicaid expansion," the authors wrote.
"This pattern may reflect both larger coverage increases over time and increasing familiarity with and utilization of coverage among the newly insured," the authors wrote.
From 2013 to 2015, the percentage of respondents who reported having a primary-care doctor increased in Arkansas from 57.2 to 63.8 percent and in Kentucky from 56.6 percent to 71.7 percent, the study found.
In Texas, that percentage fell from 52.4 percent to 51.3 percent.
During the same two-year period, the percentage of respondents with chronic illnesses, such as high blood pressure or diabetes, who reported receiving regular care for their conditions increased in Arkansas by 11.8 percentage points, to 73.6 percent.
That compared with an increase of 9.2 percentage points in Kentucky, to 78.6 percent, and a drop of 1.5 percentage points in Texas, to 63.8 percent.
The percentage of respondents who reported visiting an emergency room in the past year fell in Arkansas from 21.7 percent in 2013 to 18.5 percent in 2015.
Over the same period, that percentage increased in Kentucky from 20.4 percent to 21.9 percent and in Texas from 17.1 percent to 22.3 percent.
Meanwhile, the percentage of respondents who reported that the emergency room was where they usually go for medical care fell in Arkansas from 9.9 percent to 5.7 percent and in Kentucky from 9.3 percent to 7.9 percent.
In Texas, the percentage increased from 8.1 percent to 11.3 percent.
The study also found increases in Arkansas and Kentucky, and decreases in Texas, in the percentage of respondents who were screened for diabetes and in the average number of times a respondent had visited the doctor.
Similarly, it found decreases in Arkansas and Kentucky, and an increase in Texas, in the percentage of respondents who reported the quality of care they received to be "fair" or "poor."
The only statistically significant difference found between Arkansas and Kentucky was in the percentage of respondents with diabetes whose blood sugar had been tested. That percentage fell in Arkansas from 88.5 percent to 87.9 percent and increased in Kentucky from 84.1 percent to 95.7 percent.
In Texas, that percentage fell from 90 percent to 84.5 percent.
During a special session this year, the Arkansas Legislature endorsed changes to the private option, including charging premiums of up to $19 per month, that Gov. Asa Hutchinson has said would encourage enrollees to stay employed and take responsibility for their health care.
If approved by federal officials, the changes will take effect Jan. 1, when the state's expanded Medicaid program would officially be known as Arkansas Works.
The Medicaid program's medical director, William Golden, said in a written statement Tuesday that he doesn't expect the changes to hurt the quality of health care enrollees receive.
"In fact, we expect to continue to improve with increasingly collaborative efforts at the state and federal level," Golden said.
A Section on 08/10/2016