AUSTIN— Today, the Texas Public Policy Foundation published the paper Is Medicaid Expansion Worth It? A Review of the Evidence Suggests Targeted Programs Represent Better Policy.
“The primary impact of the Affordable Care Act (ACA) has been significantly expanding enrollment in Medicaid,” said Brian Blase, senior fellow with the Texas Public Policy Foundation’s Right on Healthcare initiative. “Medicaid expansion represents an enormous use of resources that has significantly benefitted health insurance companies and some hospitals, but almost certainly could have been expended in better ways to promote health and well-being.”
Studies have shown that the Medicaid expansion has had a mixed effect on overall health, with some evidence of improvements for the near elderly and improvements in self-reported health and mental health but also some evidence of adverse effects on younger adults, including greater opioid overdoses.
“Population health has worsened since the implementation of the ACA with life expectancy declining for three straight years from 2014 to 2017,” said David Balat, director of the Texas Public Policy Foundation’s Right on Healthcare initiative. “The conclusion from several studies suggests that the most cost-effective way to use public resources to improve health is through targeted initiatives focused on individuals who are most likely to benefit from health care and medication and through investments in child health.”
- The ACA significantly expanded insurance coverage between 2013 and 2017, but Americans’ health worsened during this period as life expectancy declined for three consecutive years from 2014 to 2017.
- States that did not adopt Medicaid expansion had favorable mortality trends from 2013 to 2017 compared with states that adopted the expansion, in part because they had fewer people die from opioid overdoses.
- Medicaid expansion was associated with improvements in self-reported health and greater financial peace of mind, with mixed evidence on physical health benefits. It was associated with a decline in mortality for those near retirement age.
- The bulk of the evidence suggests that targeted health programs, including those geared toward children, prove to be far better public investments than does a massive Medicaid expansion.
- Large coverage expansions disappoint for several reasons: the uninsured receive nearly 80 percent as much care as similar insured people, the crowd-out of private coverage, and indirect effects on others such as longer wait times for care.
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