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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Table 1

Demographic Characteristics of Adults Aged 19 to 64 Years, United States, National Health and Nutrition Examination Survey, 2007–2010

Characteristic	Current Medicaid Beneficiaries	Potentially Eligible for Medicaid Under ACA^a	P Value

			t Test	χ² Test
Mean age, y (95% CI)	38.7 (37.4–40.1)	36.3 (35.2–37.4)	.002	–
Sex, % (95% CI)			–	<.001
Male	33.3 (30.1–36.6)	49.2 (46.0–52.4)
Female	66.7 (63.4–69.9)	50.8 (47.6–54.0)
Race/ethnicity, % (95% CI)			–	.02
Non-Hispanic white	49.9 (39.8–60.1)	58.8 (48.7–68.2)
Non-Hispanic black	25.2 (19.0–32.7)	20.0 (15.3–25.6)
Mexican American	9.8 (7.3–13.1)	11.7 (6.2–21.0)
Other	15.0 (11.0–20.1)	9.6 (6.6–13.8)
Education, % (95% CI)			–	.48
Less than high school graduate	35.9 (31.6–40.5)	35.3 (29.7–41.5)
High school graduate or GED	28.1 (24.3–32.2)	31.4 (28.2–34.7)
Some college and above	36.0 (31.2–41.1)	33.3 (28.5–38.4)

ACA = Patient Protection and Affordable Care Act; GED = general equivalency diploma.
Notes: For current Medicaid beneficiaries, unweighted n = 991 and weighted N = 13.8 million; for newly eligible for Medicaid, unweighted n = 952 and weighted N = 13.6 million. Sum of percentages in each group may not equal 100 because of rounding.
↵a A US citizen with “no insurance” at the time of survey interview and a “poverty-to-income ratio” of 1.38 or less.

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Table 2

Health Measures of Adults Aged 19 to 64 Years, United States, National Health and Nutrition Examination Survey, 2007–2010

Measure	Current Medicaid Beneficiaries % (95% CI)	Potentially Eligible for Medicaid Under ACA^a % (95% CI)	P Value^b
Health status			<.001
Excellent/very good	33.5 (28.8–38.6)	34.8 (30.6–39.3)
Good	31.6 (28.6–34.7)	40.4 (36.5–44.3)
Fair/poor	35.0 (30.6–39.5)	24.8 (22.3–27.5)
Body mass index^c			.008
Normal weight	24.6 (21.3–28.2)	31.5 (28.1–35.1)
Overweight	29.9 (25.7–34.5)	29.9 (27.2–32.8)
Obese	42.9 (37.8–48.3)	34.5 (30.8–38.4)
Diabetes^d	7.5 (5.7–9.9)	5.2 (3.6–7.4)	.094
Hypertension^e	9.9 (7.9–12.4)	12.3 (10.2–14.7)	.15
Depression^f	22.3 (19.5–25.3)	15.5 (12.8–18.8)	.003
Smoking^g			.002
Never smoker	44.8 (38.9–50.8)	37.1 (32.6–42.0)
Former smoker	17.3 (13.6–21.7)	13.7 (11.0–16.9)
Current smoker	38.0 (33.0–43.3)	49.2 (43.8–54.6)
Alcohol use^h			<.001
Nondrinker	17.7 (14.0–22.0)	12.7 (9.9–16.0)
Light drinker	56.5 (50.5–62.2)	49.2 (45.2–53.2)
Moderate drinker	16.0 (12.7–20.1)	21.6 (17.5–26.5)
Heavier drinker	9.8 (8.0–12.0)	16.5 (12.9–21.0)

ACA = Patient Protection and Affordable Care Act.
↵a A US citizen with “no insurance” and a “poverty-to-income ratio” of 1.38 or less.
↵b With the χ² test.
↵c Underweight omitted (<5% of population). Body mass index was classified as normal (18.5–24.9 kg/m²), overweight (25.0–29.9 kg/m²), or obese (≥30 kg/m²).
↵d A hemoglobin A_1c level of 6.5% or greater.
↵e Systolic blood pressure 140 mm Hg or greater or diastolic blood pressure 90 mm Hg or greater. Blood pressure averaged over 3 consecutive measurements after 5-minute rest.
↵f A score of greater than 10 on 9-item Patient Health Questionnaire screen.
↵g Never smoker defined as smoking fewer than 100 cigarettes in lifetime. Former smoker defined as smoking more than 100 cigarettes in lifetime and not currently smoking. Current smoker defined as smoking more than 100 cigarettes in lifetime and currently smoking daily or some days.
↵h Nondrinkers had no drinks in the past year, including former drinkers and lifetime abstainers. Light drinkers had an average of 3 drinks or less per week. Moderate drinkers had an average of 4 to 14 drinks per week if male and 4 to 7 drinks per week if female. Heavier drinkers had an average of more than 14 drinks per week if male or an average of more than 7 drinks per week if female.

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The Article in Brief

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

Tammy Chang , and colleagues

Background Under the Patient Protection and Affordable Care Act (ACA), states will have the opportunity to expand Medicaid to millions of uninsured American adults. This study uses the most recent nationally representative data to examine the characteristics of individuals potentially eligible for Medicaid under ACA coverage expansion and compare them with current Medicaid beneficiaries.

What This Study Found The population potentially eligible for Medicaid coverage under the ACA is similarly healthy as--if not healthier than--the current Medicaid population. The exception is that tobacco smoking and alcohol use patterns are higher among potential Medicaid enrollees than for current Medicaid beneficiaries. Specifically, the analysis of data on 13.8 million current and 13.6 million eligible Medicaid beneficiaries indicates eligible adults are expected to have better health status than current beneficiaries. Additionally, the proportion of potentially eligible beneficiaries who are obese and with depression is significantly lower than current beneficiaries. There were no significant differences in the expected prevalence of diabetes or hypertension. Current tobacco smoking and moderate and heavy alcohol use are more common among the potentially eligible population than among current beneficiaries.

Implications

These findings suggest that federal Medicaid expenditures for newly covered beneficiaries may not be as high as projected by the Congressional Budget Office in the short term, thereby reducing spending anticipated with implementation of the ACA.
Given the higher prevalence of tobacco smoking and alcohol use, the authors point to the need for broad enrollment and engagement of this potentially eligible population to address their higher prevalence of modifiable risk factors for future chronic disease.