Here’s another one to add to the growing list of benefits of closing the coverage gap. A recent study in Health Affairs confirms that closing the coverage gap improves access to and affordability of care for low-income adults. Compared to states that did not expand Medicaid, states that closed the gap the first year of the ACA’s Medicaid expansion experienced:

  • A much greater decline (14 percentage points) in the uninsured rate
  • A larger reduction (10 percentage points) of low-income adults skipping prescribed medication because of cost
  • More low-income consumers getting a checkup appointment (7 percentage  points);
  • A bigger decrease in respondents having trouble paying medical bills (8.9 percentage points); and
  • A greater increase of low-income adults (11.6 percentage points) able to receive regular care for chronic conditions.

Most people would agree it is a wiser use of our taxpayer dollars to pay for preventive care and to keep chronic conditions under control rather than continue to have the uninsured use the ER when they become sick and cost more to take care of. These positive impacts speak to the trove of benefits that the 19 remaining states could also secure – if they close the coverage gap.

And it’s not just Health Affairs researchers that are seeing the value of expanding Medicaid. Indeed, policymakers who used to oppose closing the coverage gap are beginning to reverse course. For example, although Kentucky’s newly elected Governor Matt Bevin campaigned on undoing Medicaid expansion, he has changed his mind about the value of taking away the coverage gains made for hundreds of thousands of low-income Kentuckians. He is finding that closing the gap is working for his citizens (seven in ten Kentuckians want to keep Medicaid the way it is) and that it would be costly and unwise to eliminate it. As a result, the Governor is now looking to reform the program through a waiver.

The Health Affairs study also provides some important data to inform the design coverage expansion waivers. For instance, the study found that low-income consumers in Kentucky (where the state merely expanded its existing Medicaid program to cover the newly eligible) were able to pay their medical bills much more easily than those in Arkansas (where most of the newly eligible pay $5 to $25 per month, depending on income, through a private option). This may suggest that traditional Medicaid provides more comprehensive cost protections than private market expansion alternatives. This also suggests that Governors like Bevin and Arkansas’ Asa Hutchinson should be wary of changing their existing expansions to introduce new costs for beneficiaries.

Nevertheless, the study makes a strong case that it matters less how the state expands, but that it does at all – especially because access to needed care is at stake.