More access to health care is improving lives in the South


A new study finds southern states that expanded Medicaid are helping to prevent health declines among their most vulnerable citizens.

Low-income people in southern states are less likely to see their health decline if they live in a state that opted to expand Medicaid under Obamacare, a new study reveals. Still, 14 states — mostly in the South — have refused to accept the federal funds that provide 90% of the cost of the program, leaving hundreds of thousands without coverage.

The study, conducted by researchers at Vanderbilt and Harvard Universities, was published Monday in the peer-reviewed Health Affairs journal. It examined 15,356 low-income adults who were not elderly in four southern states that opted to expand Medicaid and eight southern states that opted not to, looking at their health status before (2008-13) and after (2015-17) expansion.

Beyond finding that more people in the states that opted for Medicaid expansion had Medicaid coverage ("a differential change of 7.6 percentage points"), the authors determined that "a lower proportion experienced a health status decline (-1.8 percentage points), and a higher proportion maintained their baseline health status (1.4 percentage points)."

Given that most of the people in the study were enrolled at community health centers, the authors noted that the expansion appears to help maintain good health even for those already with access to some safety-net care.

Vanderbilt University's John Graves, lead researcher on the study, told The Tennessean, "The message is pretty simple. Medicaid is keeping people from the kind of precipitous health decline that could lead to death."

When Barack Obama signed the landmark 2010 Affordable Care Act, commonly known as Obamacare, a major provision aimed to reduce the number of uninsured Americans by putting many of them into the Medicaid program. But because Medicaid is partially a federal program and partially a state one, the Supreme Court ruled in 2011 that states could choose whether to opt-in to that expansion or not. So far, 36 states have decided to opt in. But a few conservative states have refused to do so, rejecting millions in federal funding.

This study comes as Republican-controlled states and the Trump administration continue their legal assault on Obamacare. After an appellate court agreed last month with Trump that a key provision of the law is now unconstitutional, the Supreme Court is now considering whether to take the case that could determine whether the law — including its Medicaid expansion — survives. Trump ran on a vague (but oft-repeated) promise to replace Obamacare with "something terrific," but has continually avoided actually sharing what that would be over his first three years in office.

Citizens in Oklahoma and Missouri may have the chance later this year to override their GOP-controlled state governments and opt-in to expanded Medicaid by popular vote. Last year voters in Kentucky and Louisiana backed Democratic gubernatorial candidates who ran promising to preserve or improve Medicaid expansion in their states. Virginia voters also elected Democratic new majorities in both chambers of their legislature after most Republicans voted against expansion.

A National Bureau of Economic Research study last year found that more than 15,000 people have already died because their state governments did not expand Medicaid.

Published with permission of The American Independent Foundation.