Potential Adult Medicaid Beneficiaries Under the Patient Protection and Affordable Care Act Compared With Current Adult Medicaid Beneficiaries

Tammy Chang; Matthew Davis

doi:10.1370/afm.1553

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Re:The New Medicaid Patients: Opportunities and Risks
Laura K. Grubb

Published on: 18 November 2013
The New Medicaid Patients: Opportunities and Risks
Leighton Ku

Published on: 13 September 2013

Published on: (18 November 2013)
Page navigation anchor for Re:The New Medicaid Patients: Opportunities and Risks
Re:The New Medicaid Patients: Opportunities and Risks
Laura K. Grubb, Assistant Professor of Pediatrics
Chang and Davis do an admirable job identifying the characteristics of potentially newly eligible Medicaid beneficiaries under the ACA reform. As their analysis shows, new beneficiaries are anticipated to be younger, healthier, male, and of less disadvantaged backgrounds. The negative health indicators in the eligible population are greater alcohol and tobacco use, both modifiable risk factors. Overall, the population's...
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Chang and Davis do an admirable job identifying the characteristics of potentially newly eligible Medicaid beneficiaries under the ACA reform. As their analysis shows, new beneficiaries are anticipated to be younger, healthier, male, and of less disadvantaged backgrounds. The negative health indicators in the eligible population are greater alcohol and tobacco use, both modifiable risk factors. Overall, the population's profile promotes optimism as primary care providers may have the opportunity to keep healthy persons healthy and provide early interventions to address modifiable health risk factors. With ACA implementation, providers will receive Medicaid payments comparable to Medicare reimbursements, thus encouraging quality services for Medicaid beneficiaries. Additionally, ACA expands coverage of preventive health, women's and mental health services, to improve the health of the general population, which may cycle on and off Medicaid.
One identifier the authors did not examine, but did acknowledge the limitation, is geographic distribution of the newly eligible Medicaid population. Presently, 17 states have approved Medicaid expansion and 10 additional states support expansion. The staunchest expansion opponents are also states with the highest levels of uninsured and underserved persons and worst health metrics. The current exclusion of such states from expansion may skew metric the characteristics of the newly eligible Medicaid beneficiaries in favor of healthier profiles. Furthermore, the authors did not explore the difference in current Medicaid eligibility levels among states, which may significantly impact the qualified population's demographics. For example, among the states opting for expansion, currently Minnesota covers working adults at 215% of the federal poverty level compared to Arkansas with coverage at 16% of the federal poverty level. States with higher pre-expansion eligibility levels are likely to contribute significantly less persons to the Medicaid population, compared to higher (and likely less healthy) contributions from lower eligibility states. Geographic differences will significantly impact the population's characteristics and may skew federal Medicaid expenditures in unpredictable ways.
As we move forward with ACA implementation, Chang and Davis's analysis provides some useful demographic information, but the geographic variation is too great to ignore. The geographic impact on the newly eligible Medicaid population is large and unfortunately, the health care of states' residents is not equal, nor will the ACA guarantee future equality. Where you live matters for your health and for your patients' health.
Laura K. Grubb MD MPH
Competing interests: ?? None declared
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Competing Interests: None declared.
Published on: (13 September 2013)
Page navigation anchor for The New Medicaid Patients: Opportunities and Risks
The New Medicaid Patients: Opportunities and Risks
Leighton Ku, Professor of Health Policy
This article by Chang and David confirms earlier research that low- income uninsured people who are eligible for Medicaid eligibility expansions tend to be healthier than others. As they note, earlier research focused on self-reported health status, while their study uses actual clinical data from NHANES. It is a nice counterpart by a recent study by Sandra Decker, et al. (JAMA, 2013 Jun 26;309(24):2579-86) which also...
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This article by Chang and David confirms earlier research that low- income uninsured people who are eligible for Medicaid eligibility expansions tend to be healthier than others. As they note, earlier research focused on self-reported health status, while their study uses actual clinical data from NHANES. It is a nice counterpart by a recent study by Sandra Decker, et al. (JAMA, 2013 Jun 26;309(24):2579-86) which also found that the potentially eligible uninsured were healthier, but, if they had chronic health problems, were often undiagnosed so they might need some initial care to identify and initiate treatment for their health problems.
The combined message to family physicians is that if their states are expanding Medicaid (and at this point it looks like slightly more than half will), they may be presented with patients somewhat different than their previous Medicaid patients: more men, somewhat healthier but often undiagnosed because they lacked insurance before, but with some risk factors related to higher tobacco or alcohol use.
I'd add that in fact the profile may be a little more complex. A small minority of the new Medicaid enrollees have very serious problems, such as the very poor men with serious mental health or substance use problems (sometimes homeless) who were previously ineligible for Medicaid but who nonetheless churned in and out of the medical system as indigent patients. But the larger share will be lower risk people who are healthy enough to work, but not well off enough to afford insurance.
I have every trust that family practitioners will step up to address the needs of their patients. In fact, Brian Bruen and I recently published a paper in Health Affairs (Sept. 2013 32:1624-1630) finding that primary care visits have the same average length and content regardless of whether patients have Medicaid, private insurance, are uninsured or get care at community health centers, indicating that doctors focus on patients' individual heatlh needs, not their insurance status.
One of the great things about the Affordable Care Act is that it provides better opportunities to help patients (privately insured as well as Medicaid) to get preventive care, such as tobacco cessation therapies without cost-sharing. This could promote a new wave of prevention-focused care to help patients become healthier.
Competing interests: ?? None declared
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Competing Interests: None declared.