Brace yourselves, dear readers: according to a shocking study in the journal JAMA Internal MedicineCan health insurance be good for your health.
Harvard researchers surveyed the health of nearly 9,000 low-income people in Texas, Arkansas and Kentucky from 2013 to 2015. During this time, Arkansas and Kentucky expanded Medicaid healthcare under the Affordable Care Act, while Texas did not. Over the course of the study, respondents in Arkansas and Kentucky not only reported improvements in their access to and quality of care, but were five percent more likely to report being in excellent health compared to their Texas counterparts.
While the findings may not be surprising, they provide some of the first hard data that the ACA actually improves the health of the 20 million Americans insured under the Comprehensive Health Act. However, the authors caution that it is only a correlation. The data does not directly prove the role of ACA in documented health improvements. In the words of the Harvard researchers, the study design “precludes any obvious causal interpretation”.
But the data collected over three years — from 2013, before the Medicaid expansion bill went into effect, to late 2014, a year later, and again in 2015 — showed incremental improvements, with the biggest gains coming in 2015. but delayed improvements squarely with how new coverage would roll out. That is, over the course of those two years, people signed up for new policies, went to doctors’ offices, and eventually received new care and treatments.
By 2015, survey participants in Arkansas and Kentucky were 22.7 percent less likely than Texans to report having no insurance. Arkansans and Kentuckians also reported better access to primary care, fewer skipped medications due to cost, lower out-of-pocket expenses, lower chances of an emergency room visit, more outpatient visits, and more screening for chronic conditions such as heart disease and diabetes. They also reported more routine care and higher quality of care.
These results support other early studies that suggested that people who had health insurance under the ACA were less at risk of indebtedness from medical bills and more likely to receive routine and preventive care.
But perhaps the most substantial gain in the new study is the rise in the number of respondents self-reporting themselves as being in “excellent” health. Previous studies have shown that the way people describe their health is a strong predictor of their actual mortality, with those describing themselves in poor condition actually being closer to death.
Only time will tell, the authors warn, if the trends continue and lead to marked health improvements such as lower disease incidence and longer lifespan. The Harvard researchers also caution against using their study to generalize to the rest of the country. Meanwhile, they claim the study “provides support to stay on track” with Medicaid expansion in the two states. Their results may inform other states considering expansion.
The authors also note that Arkansas and Kentucky have expanded coverage in different ways. While the former offers private options and the latter expands Medicaid-managed care, the researchers found no significant difference between health outcomes in the two states.
JAMA Internal Medicine2016. DOI: 10.1001/jamainternmed.2016.4419 (About DOIs).