1. Evidence on Medicaid and the ACA Petrie-Flom Center Benjamin
Sommers, M.D., Ph.D. Harvard T.H. Chan School of Public Health
December 2017
2. Plan for Today Short presentation on research evidence to
date on the ACAs Medicaid expansion Effects of ACAs Medicaid
expansion: Patients Hospitals State budgets Alternative models of
expansion Politics of Medicaid reform 2
4. Medicaid Expansion: Coverage CMS statistics: 16.1 million
more enrollees in Medicaid/CHIP as of 8-2016, compared to 9- 2013
Survey estimates: Roughly half of gains were pre-ACA eligible
(woodwork), other half were part of early expansions or 2014
newly-eligible Uninsured rate for low-income adults fell by 5.2
percentage points from expansion 4 Sources: CMS 2016; Sommers et
al, JAMA 2015; Frean, Gruber, Sommers JHE 2017.
5. Medicaid Expansion: Better Access & Affordability 5
Source: Commonwealth Fund, In the Literature, Adapted from Sommers
et al., JAMA Int Med 2016 Changes from 2013 to 2015 after Medicaid
expansion in two states (KY and AR), compared to no expansion
(TX)
6. Quality of Care and Health 6 Source: Sommers, Orav, Blendon,
& Epstein, JAMA Internal Medicine, 2016
7. Medicaid Expansion: Increased Prescription Drug Use 7 Notes:
Rx per capita is per non-elderly adult in the state (not just
Medicaid beneficiaries). Source: Ghosh, Simon, and Sommers 2017
NBER Working Paper
8. Private Option vs. Medicaid: Both Beneficial, Few
Differences -35% -25% -15% -5% 5% 15% Excellent self-reported
health Fair/Poor quality care Diabetics Glucose Check Check-up
Regular care for chronic conditions Annual out-of-pocket spending*
Trouble paying medical bills ED is usual source of care Skipped
prescription due to cost Cost-related delay in care Personal doctor
Usual source of care Medicaid Private Insurance Uninsured MEDICAID
EXPANSION PRIVATE OPTION Notes: Bars show difference-in-differences
comparison, relative to non-expansion (Texas). * Outcome is
Log(Spending), with estimate reported as percent change. All other
estimates are percentage- points. P-value, AR vs. KY 0.28
