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Previous research has found modest changes in self-reported health and reductions in mortality associated with Medicaid expansion, but a review of 77 studies published in 2018 in Health Affairs found that 60% of assessments of health status did not find evidence of beneficial impacts from the ACA's expansion. This muddled evidence has fueled the debate over whether accepting expansion funds could improve population health.
The study, co-authored with Harvard researchers J. Michael McWilliams, MD, PhD; Laura Hatfield, PhD; Nancy Keating, MD, PhD; and VUMC research professor of Medicine William Blot, PhD, found that expansion reduced the likelihood of low-income adults experiencing a self-reported health status decline, particularly for adults with severe mental and physical limitations.
"The effect is sizable and would amount to the worst-ranked Southern state rising about halfway up the rankings in state population health if it expanded Medicaid," said McWilliams, senior author and Harvard Medical School Professor of Health Care Policy. "Unlike many other studies, we were able to focus on some of the most vulnerable populations who stand to gain the most from insurance coverage."
Of the 14 states that have not yet expanded Medicaid, nine are in the South and two border the region.
"Our research demonstrates that access to the safety net is an inadequate substitute for coverage, and that non-expanding Southern states could materially improve population health if they accept expansion funds," Graves said. "Health care policy experts and physicians have suspected this for a while but with our study, we now have the actual evidence showing that non-expanding Southern states could materially improve population health if they accept expansion funds." Source:
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