Even as the Affordable Care Act remains a political flash point, new research shows it is dramatically improving poor patients’ access to medical care in states that have used the law to expand their Medicaid safety net.
After just two years of expanded coverage, patients in expansion states are going to the doctor more frequently and having less trouble paying for it.
At the same time, the experience in those states suggests better access will ultimately improve patients’ health, as patients get more regular checkups and seek care for chronic illnesses such as diabetes and heart disease.
“The effects of expanding coverage will be an unfolding story over time,” said Dr. Benjamin Sommers, lead author of the study, published in the journal JAMA Internal Medicine. “But we are starting to see the kind of broad-based improvements that we would expect with better access.”
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The health law, often called Obamacare, nevertheless continues to be a major point of dispute in national politics, as it has been since it passed in 2010. And Republican politicians in many red states still oppose Medicaid expansion, arguing that the program is unaffordable and ineffective.
GOP presidential nominee Donald Trump has pledged to repeal the law. He has offered little indication how he would replace the expanded safety net.
Democratic nominee Hillary Clinton, by contrast, has pledged to build on the existing law. At her nominating convention last month in Philadelphia, Democrats embraced the law more overtly than they have done in previous campaigns.
That reflects a view by some Democratic strategists that opposition to the law, while still strong among core Republicans, has waned among other voters and that the added coverage can mobilize support, particularly among low-income and minority voters.
Medicaid is a key pillar of the law’s program for guaranteeing health coverage and has helped drive a historic drop in the nation’s uninsured rate. Nationwide surveys suggest at least 20 million previously uninsured Americans have gained coverage since 2014.
The law makes hundreds of billions of dollars of federal aid available to states to extend Medicaid coverage to poor adults, a population that had been largely excluded from the government safety net program.
Medicaid eligibility historically was limited to certain vulnerable populations, including low-income children, pregnant women, people with disabilities and the elderly.
The number of states that have expanded Medicaid under the law has slowly increased to 31, the most recent being Louisiana, where state officials have labored to keep up as more than 250,000 people have enrolled in the coverage since June.
But continued GOP opposition has left nearly 3 million low-income Americans without health insurance in the 19 states that haven’t expanded Medicaid, according to an analysis by the nonprofit Kaiser Family Foundation.
That is already having a profound effect, according to the new JAMA study, which builds on growing evidence showing a widening divide between states that are expanding access and those that aren’t.