Montana experiences significant positive impacts of Medicaid expansion

Today, the HELP Oversight Committee will meet for its quarterly meeting to review and discuss the implementation of Medicaid expansion in Montana. We’ll get an update on how many people have enrolled, the corresponding reduction in the uninsured rate, and the amount of federal dollars that have flowed into Montana communities for Medicaid provider payments to access affordable health care.

These numbers are impressive – well above initial projections. Tens of thousands of Montanans now have greater access to life-saving services, low or no-cost preventative care, and other health services. We will also hear from hospitals, providers, and others that are seeing the impact of improved access to health insurance.

It will be another year or two before we fully understand the scope of the economic benefits of Medicaid expansion here in Montana, but we can see from other states that the impacts are significant and far reaching. Dozens of studies have been conducted on the effects of expanding coverage, and the Kaiser Family Foundation has compiled a nice summary of that research. Here’s what they’ve found:

States that have expanded Medicaid have seen sharp declines in the number of uninsured adults. From 2012 to 2016, states that expanded Medicaid have experienced nearly 50 percent decline in the uninsured rate for non-elderly adults. This compares with a decline of non-expansion states of about 33 percent. (Because expansion states started at a lower rate, this difference in the decline really understates the effects of expansion, since non-expansion states simply had further room to drop.) States that expanded Medicaid through the federal waiver process, such as Arkansas, are seeing similar increases in coverage.

Individuals are better accessing health services. Some studies have shown that individuals are more likely to access care in expansion states, including finding a personal physician and being able to access needed medication. Additionally, expansion also appears to be having an impact on affordability of care: several studies have found that low-income families report less unmet health care needs because of financial reasons.

More work can be done to provide health insurance education to improve the kinds of services that families are accessing. The great news coming from expansion states is that low-incomes families are utilizing certain types of preventative care more, including dental visits, breast exams, and mammograms. And patients with chronic health conditions are better accessing regular care. However, some states have also seen increases in the use of hospital visits, thus emphasizing that enrollment and health insurance education go hand-in-hand.

Impact on health outcomes continues to be studied. More time is really needed to determine how Medicaid expansion impacts health outcomes; however, initial studies have shown at least some positive impact. For example, as the Kaiser report notes, a study of childless adults living below the poverty line showed that these individuals accessed greater health services resulting in “modest improvements in self-rated health and decreases in the number of work days missed due to poor health.” Similar results were found in a study of individuals who were homeless and accessing life-changing surgeries or treatment otherwise unavailable without insurance.

Economic benefits exceed expectations. States that have expanded Medicaid are experiencing considerable budgetary and economic benefits. The injection of billions of federal dollars into local economies has represented significant economic growth for these states, including growth in states’ gross domestic product (GDP), increased general fund revenue, and the creation of good paying jobs. Several state-specific studies show that these economic benefits will continue, even factoring in the required state match in the later years.

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