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Study on Medicaid expansion finds increased access to health care

by Andy Davis | January 6, 2016 at 3:19 a.m.

Low-income, non-elderly Arkansas adults were more likely last year than a year earlier to be insured and less likely to report skipping a prescription because of the cost, according to a study released Tuesday.

The study, published in the journal Health Affairs, found similar changes in Kentucky, which, like Arkansas, expanded its Medicaid program.

It found that both states appeared to make comparable gains in improving access to medical care when compared with Texas, which did not expand Medicaid.

Joe Thompson, director of the Arkansas Center for Health Improvement, said the study is "the first of probably many examinations" of the effect of Arkansas' Medicaid expansion through the private option.

Under that program, the state uses federal Medicaid funds to buy coverage for low-income Arkansans on the state's federally run health insurance exchange.

The state created the program in 2013 as a primary way of extending coverage to adults with incomes of up to 138 percent of the poverty level: $16,243 for an individual, for instance, or $33,465 for a family of four.

Kentucky expanded its Medicaid program primarily through Medicaid managed-care plans.

Texas is among 20 states that have not expanded Medicaid.

"I think the [study] results kind of validate the promise of the private option," Thompson said.

In Texas, Medicaid coverage is available to parents with incomes below 25 percent of the poverty level and disabled adults with incomes below 74 percent of the poverty level, according to the study.

Nondisabled, childless adults are not eligible for Medicaid in Texas.

Under the 2010 Patient Protection and Affordable Care Act, federal tax credits are available to some people to help buy coverage through insurance exchanges. The credits are available to people who don't qualify for Medicaid and who have incomes of 100 percent-400 percent of the federal poverty level.

People with lower incomes don't qualify for the tax credits even if they also don't qualify for Medicaid.

The study on the three states, conducted by researchers at Harvard University's public health and medical schools, was based on surveys in 2013 and 2014 of non-elderly adults with incomes of up to 138 percent of the poverty level.

It found that the percentage of adults in that income range who lacked insurance fell in Arkansas from 41.8 percent in 2013 to 19.4 percent in 2014.

Over the same period, the percentage of low-income adults who lacked insurance fell in Kentucky from 40.2 percent to 12.4 percent and in Texas from 38.5 percent to 27.1 percent.

In Arkansas, 36 percent of low-income adults reported having private insurance in 2014, compared with 19.3 percent in 2013.

By comparison, the percentage of such adults in Kentucky who reported having private insurance rose from 22.1 percent in 2013 to 28.2 percent in 2014. In Texas, the percentage rose from 28.7 percent to 32.4 percent.

The percentage of low-income adults who skipped a prescription because of the cost fell in Arkansas from 40.9 percent to 30 percent; in Kentucky from 37.5 percent to 25.8 percent; and in Texas from 28.3 percent to 26.9 percent.

Researchers found the results of Medicaid expansion in Arkansas and Kentucky to be similar, with the biggest difference in the percentage of low-income adults who reported having trouble paying their medical bills.

In Kentucky, that percentage fell by 14.3 points, from 42.7 percent in 2013 to 28.4 percent in 2014.

During the same period, the percentage of low-income adults in Arkansas who reported trouble with bills fell by 7.6 points, from 43.1 percent to 35.5 percent. In Texas, it fell 1.9 points, from 31.9 percent in 2013 to 30 percent in 2014.

The researchers wrote that the finding "would be consistent with previous research demonstrating that Medicaid's financial protection is more comprehensive than that of private insurance."

The survey included about 950 adults each year from each of the three states. The estimates had a margin of error of plus or minus 4.5 percentage points, said Benjamin Sommers, an assistant professor at the Harvard School of Public Health, who was the study's lead author.

Respondents were asked more than two dozen questions on topics such as their health and access to medical care. On some of the questions, the annual change wasn't found to be statistically significant.

Sommers said the researchers are preparing another study based on a follow-up survey conducted in 2015.

Almost 250,000 Arkansans had been approved for coverage in Arkansas' expanded Medicaid program as of Nov. 30. That included almost 199,000 enrolled in the private option and 23,000 assigned to the traditional Medicaid program because they were considered to have exceptional health needs.

Thousands of others who had been approved had not yet completed enrollment.

Gov. Asa Hutchinson has said he plans to seek federal approval for changes to the private option, including requiring some enrollees to pay premiums, referring unemployed enrollees to job-training programs and subsidizing employer-sponsored plans for those with access to job-based coverage.

Metro on 01/06/2016

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