The Far-Reaching Benefits of Medicaid Expansion
In Idaho, Nebraska, and Utah, more than 600 lives will be saved every year thanks to ballots cast in November’s midterm elections. In Maine, more than 100 additional residents will survive each year because voters dumped a governor who was stonewalling democracy. And as calendars turn to 2019, Virginia is poised to prevent more than 780 deaths per year.
The common life-saving thread? Medicaid expansion.
By expanding Medicaid under the Affordable Care Act, as 31 other states and the District of Columbia had done before them, these states will increase insurance coverage and improve access to affordable care.
But recent research also finds that expansion has many far-reaching positive effects beyond coverage and care—from improved health and reduced mortality, to greater family financial security, to enhanced public safety. In a recent study, the Center for American Progress leveraged dozens of academic studies to provide state-by-state estimates of the many benefits of expansion—benefits that policymakers in 14 remaining nonexpansion states continue to deny their constituents and the Trump administration threatens with punitive new time limits.
Saving lives and improving health
In 2016, nearly one-third of U.S. adults skipped a needed doctor’s visit or went without necessary treatment because they couldn’t afford it—a far greater share than in other wealthy nations. As a consequence, Americans live in poorer health and die earlier, with sharp disparities along racial, income, and geographic lines.
By providing insurance to the group least likely to be insured—low-income, nonelderly adults—Medicaid expansion has dramatically improved access to affordable treatments and preventative care. Research shows that for every 239 to 316 adults who gained Medicaid, one additional life was saved each year. If Medicaid were expanded in the 14 remaining nonexpansion states, at least 12,870 fewer Americans would die each year. These lifesaving consequences include modest but meaningful effects on infant mortality, since Medicaid expansion insures many women during their child-bearing years and adverse infant outcomes are more likely when mothers are uninsured or sporadically insured.
Further research shows how Medicaid expansion helps combat two major killers—cancer and opioid overdoses. Expansion significantly boosts the odds of detecting cancer at an early stage, which lowers treatment costs and boosts survival rates. Across the 14 holdout states, expansion could mean 4,330 more early diagnoses each year.
And Medicaid expansion has been a critical tool for fighting the opioid crisis, which killed roughly 115 Americans every day during 2017. In nonexpansion states, high uninsurance rates among low-income working-age adults—who are disproportionately affected by opioid use disorder—means less access to substance abuse treatment and higher costs for uncompensated care. In expansion states, by contrast, uninsured opioid-related hospitalizations dropped precipitously in the wake of Medicaid expansion. If all nonexpansion states adopted expansion, uninsured opioid-related hospital visits would drop by more than 16,000 each year.
Boosting family financial security
While a large share of nonelderly American adults—1 in 4, as of 2015—reported they or a household member struggled to pay a medical bill in the previous year, this share nearly doubled among nonelderly adults who lacked insurance. Multiple studies demonstrate how Medicaid expansion has helped stabilize and improve families’ finances and protect them from spirals into debt and poverty.
By providing low-cost access to preventative care and treatment, Medicaid expansion has reduced newly accrued medical debt among enrollees by 30 percent or more in expansion states—an average savings of $920 per person. Further research finds that Medicaid expansion has substantially shrunk the amount of delinquent debt sent to third-party collection agencies by improving Americans’ ability to pay their bills, both medical and nonmedical. If their states expanded, residents of the 14 nonexpansion states would see unpaid medical bills fall by $6 billion and collection balances fall by a staggering $7.5 billion.
When families face overwhelming debt they can’t pay—oftentimes driven by medical bills—bankruptcy may become the only option. Studies find that Medicaid expansion has prevented tens of thousands of bankruptcies; an investigation of Michigan, for example, found that bankruptcies among new coverage gainers decreased by 10 percent following expansion. Furthermore, as a result of improved economic circumstances—including reduced bankruptcy risk, fewer unpaid medical bills, and less delinquent debt—Medicaid expansion has made families in expansion states more creditworthy, boosting their credit scores and giving them lower-cost access to credit. That translates into direct savings when families go to buy a house or car, take out a personal loan, or apply for a credit card. Adopting Medicaid expansion in every state would prevent nearly 1,350 bankruptcies and save families $1.9 billion annually through less costly credit.
Enhancing public safety
The United States’ history of mass incarceration and overcriminalization means that as many as 1 in 3 American adults has a criminal record. Individuals who face obstacles to employment such as a criminal record or labor-market discrimination often cannot access health care and other vital services they need to successfully enter and remain in the labor market. For individuals who are returning to their communities after justice-system involvement, even when they are able to overcome barriers to employment, they are likely to work in poorly paid, low-quality jobs that do not offer health care.
By enabling low-income working-age adults, who the justice system disproportionately affects, to access necessary medications, mental health services, and substance abuse treatments, Medicaid expansion has removed a major barrier to successful re-entry. Rigorous research finds this has substantially enhanced public safety, saving expansion-state communities tens of billions of dollars each year in reduced costs of crime. If their states expanded, communities in nonexpansion states stand to save $7 billion per year.
President Trump’s work requirements threaten the benefits from Medicaid expansion
Unfortunately, the Trump administration is seeking to strip Americans of these far-reaching benefits. After his failed legislative attempts to cut Medicaid, Trump has taken a backdoor approach to sabotaging the program by encouraging states to introduce so-called work requirements. These requirements function as harsh time limits that take away health care from workers when they cannot find a job or get enough hours at work.
Arkansas has rapidly become a harbinger of Trump’s damage. From June to December 2018, an estimated 17,000 Arkansans had their Medicaid coverage taken due to the state’s harsh new work requirements. Evidence suggests that for the vast majority of those who were subject to the policy and lost coverage, it not because they were not working, but for reasons such as difficulty documenting a fluctuating work schedule or inability to accessing the online portal. Yet even as advocates sound alarm bells on Arkansas, fourteen other states have similar work-requirement plans underway—including newly expanding Virginia, where the state’s Republican legislators forced Democrats to include work requirements in exchange for expansion.
Taking away jobless workers’ health care won’t help them find a job any faster—and may actually be counterproductive—but it will curb the widespread positive effects of Medicaid expansion on workers’ health, families’ financial security, and communities’ public safety. If state and national policymakers were serious about improving Americans’ lives, they would expand this lifesaving program in every state—without Trump’s cruel strings attached.
Rachel West is the director of research for the Poverty to Prosperity Program at the Center for American Progress.