People Who Gained Coverage Under Obamacare Saved $340 a Year

One facet of the 2010 Affordable Care Act was an expansion of Medicaid. Obamacare increased the eligibility for the program—funded jointly by the states and federal government and administered by the states—to 138 percent of the federal poverty line and offered states additional money to cover the newly eligible enrollees. In 2012, the Supreme Court ruled that states could, but didn't have to, take the cash. Thirty one states and Washington DC opted to expand Medicaid while 19 did not.

This created a laboratory to test the effectiveness of the expansion program, according to Benjamin D. Sommers, associate professor of health policy and economics at Harvard University's TH Chan School of Public Health. "We found states with similar [income] demographics and similar health outcomes," Sommers says, but they responded differently to the offer of extra money to help insure their poor.

The results of a four-year study, of which Sommers is lead author, were published in Health Affairs on Wednesday. The poor in two states that took federal money to expand medical coverage, Kentucky and Arkansas, had significant decreases in uninsured rates and low-income people reported less trouble paying for care when compared to poor residents of Texas, a state that declined the money. People who gained coverage in Kentucky and Arkansas were more likely to say they had a regular place of care and report "excellent" health.

The implications for the effort to repeal the law—a bill for which passed the House on May 4 and is heading to the Senate, should be obvious—Sommers says. "If those federal dollars were lost, states would have to decrease eligibility or services."

Sommers and his coauthors hired a scientific polling firm to contact adults aged 19 to 64 with an income that made them eligible for Medicaid under the ACA; they were called via landline and cell phone. Those surveyed were not exclusively insured through the ACA—some got coverage through work, a spouse or other means, and some uninsured—but Sommers says it was his goal to understand the totality of healthcare changes for that low-income population throughout the years the ACA was implemented.

The poor of Kentucky and Arkansas, dubbed "expansion states" in the study, experienced significantly better changes in healthcare during the study period than those of the "non-expansion state," Texas. People who gained coverage under the ACA saw big improvements: on average, adults had a 41 percent increase in having a regular doctor, significant increases in preventive health visits, and a 23 percent increase in reporting that they were in excellent health. And their annual out-of-pocket health costs decreased by $337. People with chronic conditions like diabetes, heart disease, and asthma and gained coverage under the ACA reported getting more regular care, taking their medications more regularly, and better self-reported health.

These improvements among newly-covered folks helped lower-income people overall. By 2016, poor Kentuckians and Arkansans were 20.7 percent more likely than Texans in the same income bracket to report having health insurance. By that same year, those Arkansans and Kansans were 16.7 percent more likely than those Texans to have a usual doctor, 11.1 percent more likely to say they'd had a checkup in the past year, 11.2 percent more likely to get care for a chronic condition and 5.1 percent more likely to say they were in "excellent" health.

Similarly, people in this income block in Arkansas and Kentucky were less likely to report problems paying for healthcare than Texans of similar means. They were 12.8 percent less likely to delay care due to cost, 10.9 percent less likely to report difficulty paying medical bills, and 10.5 percent less likely to skip medication because of cost.

During the Obamacare years, the uninsured rate of low-income adults dropped to 7.4 percent in Kentucky, 11.7 percent in Arkansas, and 28.2 percent in Texas—all from about 40 percent in 2013, with the sharpest drops immediately after the implementation of the law. Overall, the ACA helped cut the insured rate in half nationally, from about 16 percent to 8.6 percent of all Americans, which meant that an additional 21.3 million people got health insurance. The more people who have health insurance, the healthier we'll all be.

Sommers says there was little substantial difference in outcomes between Arkansas and Kentucky, despite their differing methods of expansion: Arkansas used the Medicaid money to help subsidize residents' private insurance plans while Kentucky simply used it to get more people on Medicaid.

"This is one of the first studies to show the effects of the [Affordable Care] Act after it was implemented," Sommers says. "It's hard for me to predict what the Senate is going to do, but with the House bill, Medicaid is being cut significantly and the benefits we've seen would be washed away."

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