Medicaid expansion is a key component of the coverage mandate in the Patient Protection and Affordable Care Act (ACA). States were offered a chance to expand their Medicaid programs - with the federal government providing almost all of the funding - to ensure that coverage can be provided to the vast majority of state residents. Many states opted not to expand their Medicaid programs creating an income range (gap) for people who earn too much to qualify for Medicaid and too little to receive subsidized health insurance on the federal exchanges. Large numbers of the people for whom PPACA was supposed to provide coverage, fall into this gap and are still unable to afford health insurance.
Over five year period leading up to the launch of ACA, the Commonwealth Fund's Scorecard on State Health System Performance, 2014, reveals mixed results both within states and between states on measures of Access and Affordability, Prevention and Treatment, Cost Controls and Health Outcomes. Majority of states had stagnant or worse results on two thirds of the measures including going without care due to cost, preventative care utilization or linking children to primary care physicians. The majority of states had improvements on one third of the health care performance measures including childhood immunizations, patient-centered care, avoidable hospital visits, Medicare re-admissions, and cancer-related deaths from 2007 to 2012. Many of the measures demonstrating improvement within states are linked to national, state and local initiative aimed at those measures. The difference between best and worst performing states is between two and eight on key indicators, with smaller gaps on items showing the largest improvement – which are the same indicators on which federal and state efforts have focused. This demonstrates the ability of both federal and state efforts to improve public health and control overall costs increases.
The potential problem
It should be noted that when it comes to the ability of states to improve health care and control costs, a lack of Medicaid expansion could significantly hinder them, the report said. Those that took advantage of the expansion are likely to see health quality grow significantly in the coming years, while those that do not will continue to fall behind their neighbors as uninsured residents falling into the income gap forgo needed care due to cost, do not utilize preventive care and experience medically avoidable deaths.
Insurance companies operating in multiple states may want to keep an eye on which have not implemented Medicaid expansion to fill the coverage gap. Insurers may be able to help residents of these states with the most affordable coverage available, or they may find themselves facing costs rising faster in those states due to uncovered care, poor utilization of lower cost preventative care and overall higher costs associated with caring for a less health population.