Patients in Medicaid expansion states say they have better healthcare access and fewer unmet care needs than those in non-expansion states.
Low-income adult patients living in Medicaid expansion states tend to have better access to healthcare services than patients living in non-expansion states, according to a new report from the Government Accountability Office.
The report explored how low-income adult patients living below 153 percent of the federal poverty level access healthcare since the Affordable Care Act allowed states to opt into Medicaid expansion. As of December 2017, 31 states had chosen the Medicaid expansion route.
Using 2016 data from the National Health Interview Survey, GAO revealed that patients living in those expansion states tend to have better access to the healthcare industry than those in non-expansion states. Patients with access to health payer coverage also tended to fare better, GAO showed.
Overall, 5.6 million patients ages 19 to 64 had incomes that qualified them for Medicaid under the program’s expansion parameters spelled out in the ACA. About 1.9 million of those patients lived in a state that had expanded Medicaid, while the rest lived in a non-expansion state.
Patients living in expansion states were more likely to say that all of their medical needs had been met, the survey showed. Twenty-six percent of low-income adults in expansion states said they still have unmet medical needs, compared to 40 percent of those in non-expansion states.
Similarly, adults reporting insurance coverage, regardless of their home state, were more likely to say all of their medical needs have been met, compared to those without insurance access.
These findings suggest that those living in non-expansion states have limited access to healthcare that stems from their healthcare coverage. Patients living in an expansion state might find healthcare plans more affordable, and therefore reap the benefits of coverage.
Patients living in expansion states were also less likely to say they cannot afford an office visit. Only 9 percent of those in expansion states had financial barriers to care, compared to 20 percent of those in non-expansion states.
Again, insurance access had something to do with patient care access, the report showed. Twelve percent of insured patients living in any state experienced financial barriers to care, compared to 27 percent of uninsured patients.
Patients also face other barriers to care, the report revealed. Specifically, the same number of low-income adults with and without insurance coverage reported transportation or other non-financial barriers to care.
This is likely suggestive of the social determinants of health and health disparities most low-income adults experience.
Although transportation was categorized as a “non-financial barrier” for the purposes of the report, it may still be indicative of a patient’s financial constraints. These patients do not have access to their own car, reliable public transportation, or a friend or family member able to drive them to the health facility.
Patients living in expansion states were more likely to report having a regular place to receive care when they fall ill compared to those in non-expansion states – 82 percent of expansion state patients compared to 68 percent non-expansion state patients.
Seventy-eight percent of low-income adults who were insured, regardless of what state they come from, are more likely to have a regular place to access care compared to 46 percent of patients in other states.
Regardless of these disparities, the researchers did find that similar proportions of patients are accessing selected health services, such as a flu shot or blood pressure check.
Although the report authors did not necessarily draw conclusions from the data, the information is revealing.
In particular, this data suggests that patients with access to health payer coverage fare better than those without access. These patients are more likely to access healthcare services free of monetary barriers.
Living in a state that has expanded Medicaid per ACA allowances makes it more likely that patients will obtain that health payer coverage. This is likely because Medicaid and other plans have become more affordable and accessible in those states.
Other researchers have broached the subject of patient care access under the ACA’s Medicaid expansion. Research presented at the 2017 American Society for Radiation Oncology’s annual meeting showed that patients living in Medicaid expansion states were more likely to obtain health payer coverage than those living in non-expansion states.
And although this means more patients might be accessing primary care, other research suggests this hasn’t been too significant a problem.
Data from a 2017 study published in JAMA Internal Medicine showed that access to primary care was still plentiful in expansion states, despite the influx of patients accessing services with their new payer coverage. However, the researchers did find that patients experienced longer wait times, even if they were able to schedule an appointment.
“The appointment availability results should ease concerns that the Affordable Care Act would exacerbate the primary care shortage,” the researchers said. “Primary care practices may be adapting to an influx of new patients with shorter visits and more rigorous management of no-shows.”
However, separate studies indicate that there is still room for improvement. Although some patients saw increased healthcare access following Medicaid expansion, some minority patients have yet to feel the positive effects.
A 2017 study published in the Annals of Family Medicine found that Hispanic patients did not see improved care access following Medicaid expansion, at least to the levels of their white or black counterparts.
“Although we found improvements across all racial and ethnic groups, important disparities remain,” the team explained. “For example, Hispanic patients maintained the highest uninsured visit rates, and the decline in uninsured visits was significantly less for this group than for non-Hispanic white and non-Hispanic black patients after Medicaid expansion.”
Limited patient education and navigation services for Hispanic communities, coupled with access restrictions for undocumented immigrants, may have limited Hispanic patient access to Medicaid expansion.
Going forward, states should consider these health disparities as they design their patient navigator programs. As states grapple with more limited funding for patient navigator programs, they may need to overhaul their entire systems. Part of those overhauls may be systems to bolster minority patients who still face considerable care access disparities.
Date: October 19, 2018