Medicaid Expansion, Mental Health, and Access to Care among Childless Adults with and without Chronic Conditions
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While the Affordable Care Act’s (ACA) Medicaid expansion has increased insurance coverage, its effects on health outcomes have been mixed. This may be because previous research did not disaggregate mental and physical health or target populations most likely to benefit.
To examine the association between Medicaid expansion and changes in mental health, physical health, and access to care among low-income childless adults with and without chronic conditions.
We used a difference-in-differences analytical framework to assess differential changes in self-reported health outcomes and access to care. We stratified our analyses by chronic condition status.
Childless adults, aged 18–64, with incomes below 138% of the federal poverty level in expansion (n = 69,620) and non-expansion states (n = 57,628).
Active Medicaid expansion in state of residence.
Self-reported general health; total days in past month with poor health, poor mental health, poor physical health, or health-related activity restrictions; disability; depression; insurance coverage; cost-related barriers; annual check-up; and personal doctor.
Medicaid expansion was associated with reductions in poor health days (−1.2 days [95% CI, −1.6,-0.7]) and days limited by poor health (−0.94 days [95% CI, −1.4,-0.43]), but only among adults with chronic conditions. Trends in general health measures appear to be driven by fewer poor mental health days (−1.1 days [95% CI, −1.6,-0.6]). Expansion was also associated with a reduction in depression diagnoses (−3.4 percentage points [95% CI, −6.1,-0.01]) among adults with chronic conditions. Expansion was associated with improvements in access to care for all adults.
Medicaid expansion was associated with substantial improvements in mental health and access to care among low-income adults with chronic conditions. These positive trends are likely to be reversed if Medicaid expansion is repealed.
This research was funded with support from the Robert Wood Johnson Clinical Scholars Program and the Ann Arbor VA Healthcare System.
Compliance with Ethical Standards
Conflict of Interest
All authors declare that they have no conflict of interest.
- 1.Status of state action on the Medicaid expansion decision. The Henry J. Kaiser Family Foundation. http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/?currentTimeframe=0. Published October 14, 2016. Accessed December 29, 2016.
- 2.McMorrow S, Kenney GM, Long SK, Gates JA. The ACA Medicaid Expansion Led to Widespread Reductions in Uninsurance among Poor, Childless Adults. Washington, D.C.: Urban Institute; 2017. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2017/rwjf436464. Accessed April 12, 2017.Google Scholar
- 3.Health Policy Brief: Uninsurance Rates and the Affordable Care Act. Health Aff (Millwood). May 2016. http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=157. Accessed December 29, 2016.
- 9.Miilunpalo S, Vuori I, Oja P, Pasanen M, Urponen H. Self-rated health status as a health measure: the predictive value of self-reported health status on the use of physician services and on mortality in the working-age population. J Clin Epidemiol. 1997;50(5):517-528. https://doi.org/10.1016/S0895-4356(97)00045-0.CrossRefPubMedGoogle Scholar
- 14.Medicaid eligibility for adults as of January 1, 2014. The Henry J. Kaiser Family Foundation. http://kff.org/medicaid/fact-sheet/medicaid-eligibility-for-adults-as-of-january-1-2014/. Published October 1, 2013. Accessed April 28, 2017.
- 15.Galbraith AA, Ross-Degnan D, Soumerai SB, Rosenthal MB, Gay C, Lieu TA. Nearly half of families in high-deductible health plans whose members have chronic conditions face substantial financial burden. Health Aff (Millwood). 2011;30(2):322–31. https://doi.org/10.1377/hlthaff.2010.0584.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Behavioral Risk Factor Surveillance System: 2015 Summary Data Quality Report. Atlanta, GA: Centers for Disease Control and Prevention; 2015.Google Scholar
- 19.Behavioral Risk Factor Surveillance System - Improving Survey Methodology. Public Health Surveillance and Informatics Program Office. Centers for Disease Control and Prevention; 2012. https://www.cdc.gov/brfss/factsheets/pdf/DBS_BRFSS_survey.pdf. Accessed August 9, 2017.
- 23.Health-Related Quality of Life (HRQOL) - Methods and Measures. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/hrqol/methods.htm#3. Published May 27, 2016. Accessed April 28, 2017.
- 28.Wherry LR, Miller S. Early coverage, access, utilization, and health effects associated with the Affordable Care Act Medicaid expansions - a quasi-experimental study. Ann Intern Med. 2016. https://doi.org/10.7326/M15-2234.
- 29.Oberlander J. The end of Obamacare. N Engl J Med. November 2016. https://doi.org/10.1056/NEJMp1614438.
- 30.Jost T. House passes AHCA: how it happened, what it would do, and its uncertain Senate future. Health Aff (Millwood). May 2017. http://healthaffairs.org/blog/2017/05/04/house-passes-ahca-how-it-happened-what-it-would-do-and-its-uncertain-senate-future/. Accessed May 8, 2017.
- 34.Saloner B. An update on “insurance coverage and treatment use under the Affordable Care Act among adults with mental and substance use disorders.” Psychiatr Serv. 2017;68(3):310–1. https://doi.org/10.1176/appi.ps.201600566.
- 35.Courtemanche C, Marton J, Ukert B, Yelowitz A, Zapata D. Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health. NBER Working Paper 23269, National Bureau of Economic Research; 2017. https://doi.org/10.3386/w23269.