title: Both The 'Private Option' And Traditional Medicaid Expansions Improved Access To Care For Low-Income Adults.
abstract: Under the Affordable Care Act, thirty states and the District of Columbia have expanded eligibility for Medicaid, with several states using Medicaid funds to purchase private insurance (the "private option"). Despite vigorous debate over the use of private insurance versus traditional Medicaid to provide coverage to low-income adults, there is little evidence on the relative merits of the two approaches. We compared the first-year impacts of traditional Medicaid expansion in Kentucky, the private option in Arkansas, and nonexpansion in Texas by conducting a telephone survey of two distinct waves of low-income adults (5,665 altogether) in those three states in November-December 2013 and twelve months later. Using a difference-in-differences analysis, we found that the uninsurance rate declined by 14 percentage points in the two expansion states, compared to the nonexpansion state. In the expansion states, again compared to the nonexpansion state, skipping medications because of cost and trouble paying medical bills declined significantly, and the share of individuals with chronic conditions who obtained regular care increased. Other than coverage type and trouble paying medical bills (which decreased more in Kentucky than in Arkansas), there were no significant differences between Kentucky's traditional Medicaid expansion and Arkansas's private option, which suggests that both approaches improved access among low-income adults.
authors.affiliation: Benjamin D. Sommers (bsommers@hsph.harvard.edu) is an assistant professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and in the Department of Medicine at Brigham and Women's Hospital, both in Boston, Massachusetts.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Sommers
authors.affiliation: Robert J. Blendon is the Richard L. Menschel Professor of Health Policy and Political Analysis in the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Blendon
authors.affiliation: E. John Orav is an associate professor of biostatistics at Harvard Medical School and in the Department of Medicine at Brigham and Women's Hospital.
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
mesh_terms: D000328:Adult; D001131:Arkansas; D004219:District of Columbia; D005260:Female; D018166:Health Care Reform / Q000191:economics; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007629:Kentucky; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D011203:Poverty / Q000706:statistics & numerical data*; D017149:Private Sector / Q000191:economics* / Q000706:statistics & numerical data; D058996:Quality Improvement; D013781:Texas; D014481:United States; D055815:Young Adult
keywords: Access To Care; Health Reform; Insurance Coverage < Insurance; Medicaid; State/Local Issues