Did Medicaid Expansion Improve Health? Nine Years of Follow-Up Data Show Limited Impact

By Liam Sigaud & Markus Bjoerkheim of Mercatus.

"The expansion of Medicaid under the Affordable Care Act has reduced the uninsured rate and increased healthcare use. But in “Did Medicaid Expansion Improve Health? Nine Years of Follow-Up Data Show Limited Impact,” Liam Sigaud and Markus Bjoerkheim show how the program’s expansion has not achieved one of its central goals— improving the health of low-income adults.

An Under-Examined Issue

Since 2014, the expansion of Medicaid has resulted in the addition of more than 19 million new program recipients. Multiple studies have examined its effects on various areas—such as insurance coverage, access to care, use of medical services, and financial security. However, there is comparatively little research on the impact of Medicaid expansion on direct health measures and outcomes. Moreover, those studies that have been conducted typically focus on the effects over short time horizons (generally one to three years post-treatment) and find mixed results.

To examine the impact of Medicaid expansion on health, Sigaud and Bjoerkheim use data from telephone surveys that asked randomly selected American adults to rate their general, physical, and mental health on standardized scales. They tracked the effects of expansion for nine years after the policy’s implementation in most states, allowing potentially noteworthy effects to emerge with a lag.

A Program Failing to Meet Its Goals

The authors find little evidence that Medicaid expansion has meaningfully and durably affected the health of low-income individuals targeted to gain coverage.

• Such individuals reported being in better health (especially mental health) during the first few years immediately after the expansion was implemented.
• Health improvements appear to have been temporary and small in magnitude.
• After about three years, people who benefited from Medicaid expansion and those who did not are statistically indistinguishable on virtually all health measures. Some evidence even indicates a potential deterioration in some health outcomes among expansion recipients toward the end of the study period.

A Poor Return for Taxpayers

The cost of Medicaid expansion exceeds $140 billion per year, or about $800 per average US household. Yet this study suggests that Medicaid expansion has failed to show that it is worth the expenditure by taxpayers. The policy has not delivered durable health gains for the group targeted to receive insurance coverage, highlighting the limits of large-scale government programs in delivering lasting benefits to the poor."