Editing Medicaid (section)

== Effects ==

=== Coverage gains ===
A 2019 review by Kaiser Family Foundation of 324 studies on Medicaid expansion concluded that "expansion is linked to gains in coverage; improvements in access, financial security, and some measures of health status/outcomes; and economic benefits for states and providers."<ref name=":7" />

=== Mortality and disability reduction ===
A 2021 study found that Medicaid expansion as part of the Affordable Care Act led to a substantial reduction in mortality, primarily driven by reductions in disease-related deaths.<ref name=":8">{{Cite journal|last1=Miller|first1=Sarah|last2=Johnson|first2=Norman|last3=Wherry|first3=Laura R|date=2021|title=Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data*|journal=The Quarterly Journal of Economics|volume=136|issue=3|pages=1783–1829|doi=10.1093/qje/qjab004|issn=0033-5533|doi-access=free}}</ref> A 2018 study in the ''[[Journal of Political Economy]]'' found that upon its introduction, Medicaid reduced infant and child mortality in the 1960s and 1970s.<ref name=":2">{{cite journal |last1=Goodman-Bacon |first1=Andrew |title=Public Insurance and Mortality: Evidence from Medicaid Implementation |journal=Journal of Political Economy |date=February 2018 |volume=126 |issue=1 |pages=216–262 |doi=10.1086/695528 |s2cid=158783532 |url=http://www-personal.umich.edu/~ajgb/medicaid_ajgb.pdf |access-date=September 16, 2019 |archive-date=December 12, 2019 |archive-url=https://web.archive.org/web/20191212175938/http://www-personal.umich.edu/~ajgb/medicaid_ajgb.pdf |url-status=dead }}</ref> The decline in the mortality rate for nonwhite children was particularly steep.<ref name=":2" /> A 2018 study in the ''American Journal of Public Health'' found that the infant mortality rate declined in states that had Medicaid expansions (as part of the Affordable Care Act) whereas the rate rose in states that declined Medicaid expansion.<ref>{{cite journal |last1=Bhatt |first1=Chintan B. |last2=Beck-Sagué |first2=Consuelo M. |title=Medicaid Expansion and Infant Mortality in the United States |journal=American Journal of Public Health |date=April 2018 |volume=108 |issue=4 |pages=565–7 |pmid=29346003 |pmc=5844390 |doi=10.2105/ajph.2017.304218 }}</ref> A 2020 ''JAMA'' study found that Medicaid expansion under the ACA was associated with reduced incidence of advanced-stage breast cancer, indicating that Medicaid accessibility led to early detection of breast cancer and higher survival rates.<ref>{{Cite journal|last1=Blanc|first1=Justin M. Le|last2=Heller|first2=Danielle R.|last3=Friedrich|first3=Ann|last4=Lannin|first4=Donald R.|last5=Park|first5=Tristen S.|date=2020-07-01|title=Association of Medicaid Expansion Under the Affordable Care Act With Breast Cancer Stage at Diagnosis|url= |journal=JAMA Surgery|language=en|volume=155|issue=8|pages=752–758|doi=10.1001/jamasurg.2020.1495|pmc=7330827|pmid=32609338}}</ref> A 2020 study found no evidence that Medicaid expansion adversely affected the quality of health care given to Medicare recipients.<ref>{{Cite journal|last1=Carey|first1=Colleen M.|last2=Miller|first2=Sarah|last3=Wherry|first3=Laura R.|date=2020|title=The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare|url=https://www.aeaweb.org/articles?id=10.1257/app.20190176|journal=American Economic Journal: Applied Economics|language=en|volume=12|issue=4|pages=288–318|doi=10.1257/app.20190176|s2cid=225044690|issn=1945-7782}}</ref> A 2018 study found that Medicaid expansions in [[New York (state)|New York]], Arizona, and Maine in the early 2000s caused a 6% decline in the mortality rate: "HIV-related mortality (affected by the recent introduction of antiretrovirals) accounted for 20% of the effect. Mortality changes were closely linked to county-level coverage gains, with one life saved annually for every 239 to 316 adults gaining insurance. The results imply a cost per life saved ranging from $327,000 to $867,000 which compares favorably with most estimates of the value of a statistical life."<ref>{{cite journal|last1=Sommers|first1=Benjamin D.|date=July 2017|title=State Medicaid Expansions and Mortality, Revisited: A Cost-Benefit Analysis|url=https://dash.harvard.edu/bitstream/1/27305958/1/Mcaid%20Mortality%20Revisited%20DASH%20Version.pdf|journal=American Journal of Health Economics|volume=3|issue=3|pages=392–421|doi=10.1162/ajhe_a_00080|s2cid=53488456}}</ref>

A 2016 paper found that Medicaid has substantial positive long-term effects on the health of recipients: "Early childhood Medicaid eligibility reduces mortality and disability and, for whites, increases extensive margin labor supply, and reduces receipt of disability transfer programs and public health insurance up to 50 years later. Total income does not change because earnings replace disability benefits."<ref name=":0">{{cite journal|last1=Goodman-Bacon|first1=Andrew|date=December 2016|title=The Long-Run Effects of Childhood Insurance Coverage: Medicaid Implementation, Adult Health, and Labor Market Outcomes|url=https://www.nber.org/papers/w22899|journal=NBER Working Paper|series=Working Paper Series |publisher=National Bureau of Economic Research|pages=22899|doi=10.3386/w22899|doi-access=free}}</ref> The government recoups its investment in Medicaid through savings on benefit payments later in life and greater payment of taxes because recipients of Medicaid are healthier: "The government earns a discounted annual return of between 2% and 7% on the original cost of childhood coverage for these cohorts, most of which comes from lower cash transfer payments."<ref name=":0" /> A 2019 [[National Bureau of Economic Research]] paper found that when [[Hawaii]] stopped allowing [[Compact of Free Association|Compact of Free Association (COFA)]] migrants to be covered by the state's Medicaid program that Medicaid-funded hospitalizations declined by 69% and emergency room visits declined by 42% for this population, but that uninsured ER visits increased and that Medicaid-funded ER visits by infants substantially increased.<ref>{{Cite journal |last1=Halliday |first1=Timothy J |last2=Akee |first2=Randall Q |last3=Sentell |first3=Tetine |last4=Inada |first4=Megan |last5=Miyamura |first5=Jill |date=2019 |title=The Impact of Medicaid on Medical Utilization in a Vulnerable Population: Evidence from COFA Migrants |url=http://www.nber.org/papers/w26030 |journal=nber.org |series=Working Paper Series |doi=10.3386/w26030 |s2cid=198255625 |hdl-access=free |hdl=10419/215175}}</ref> Another NBER paper found that Medicaid expansion reduced mortality.<ref>{{Cite journal |last1=Miller |first1=Sarah |last2=Altekruse |first2=Sean |last3=Johnson |first3=Norman |last4=Wherry |first4=Laura R |date=2019 |title=Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data |url=http://www.nber.org/papers/w26081 |journal=National Bureau of Economic Research |series=Working Paper Series |doi=10.3386/w26081 |s2cid=164463149}}</ref>

A 2021 ''American Economic Review'' study found that early childhood access to Medicaid "reduces mortality and disability, increases employment, and reduces receipt of disability transfer programs up to 50 years later. Medicaid has saved the government more than its original cost and saved more than 10 million quality adjusted life years."<ref>{{Cite journal |last=Goodman-Bacon |first=Andrew |date=2021 |title=The Long-Run Effects of Childhood Insurance Coverage: Medicaid Implementation, Adult Health, and Labor Market Outcomes |url=https://www.aeaweb.org/articles?id=10.1257/aer.20171671 |journal=American Economic Review |language=en |volume=111 |issue=8 |pages=2550–2593 |doi=10.1257/aer.20171671 |issn=0002-8282 |s2cid=237710097}}</ref>

=== Rural hospitals boosted revenue ===
A 2020 study found that Medicaid expansion boosted the revenue and operating margins of rural hospitals, had no impact on small urban hospitals, and led to declines in revenue for large urban hospitals.<ref>{{Cite journal|last1=Moghtaderi|first1=Ali|last2=Pines|first2=Jesse|last3=Zocchi|first3=Mark|last4=Black|first4=Bernard|date=2020|title=The effect of Affordable Care Act Medicaid expansion on hospital revenue|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.4157|journal=Health Economics|language=en|volume=29|issue=12|pages=1682–1704|doi=10.1002/hec.4157|issn=1099-1050|pmid=32935892|s2cid=221748484}}</ref> A 2021 study found that expansions of adult Medicaid dental coverage increasingly led dentists to locate to poor, previously underserved areas.<ref>{{Cite journal|date=2021|title=Medicaid and provider supply|url=https://www.sciencedirect.com/science/article/abs/pii/S0047272721000669|journal=Journal of Public Economics|language=en|volume=200|doi=10.1016/j.jpubeco.2021.104430|issn=0047-2727|last1=Huh|first1=Jason|page=104430|s2cid=236254325}}</ref> A 2019 paper by [[Stanford University]] and [[Wharton School]] economists found that Medicaid expansion "produced a substantial increase in hospital revenue and profitability, with larger gains for government hospitals. On the benefits side, we do not detect significant improvements in patient health, although the expansion led to substantially greater hospital and emergency room use, and a reallocation of care from public to private and better-quality hospitals."<ref>{{cite journal |last1=Duggan |first1=Mark |last2=Gupta |first2=Atul |last3=Jackson |first3=Emilie |title=The Impact of the Affordable Care Act: Evidence from California's Hospital Sector |journal=NBER Working Paper |series=Working Paper Series |date=2019 |pages=25488 |url=http://www.nber.org/papers/w25488 |publisher=National Bureau of Economic Research |doi=10.3386/w25488 |s2cid=169278577 |doi-access=free }}</ref>

=== Financial and health security increase ===
A 2017 survey of the academic research on Medicaid found it improved recipients' health and financial security.<ref name=":1" /> Studies have linked Medicaid expansion with increases in employment levels and student status among enrollees.<ref>{{Cite journal|last1=Tipirneni|first1=Renuka|last2=Ayanian|first2=John Z.|last3=Patel|first3=Minal R.|last4=Kieffer|first4=Edith C.|last5=Kirch|first5=Matthias A.|last6=Bryant|first6=Corey|last7=Kullgren|first7=Jeffrey T.|last8=Clark|first8=Sarah J.|last9=Lee|first9=Sunghee|last10=Solway|first10=Erica|last11=Chang|first11=Tammy|date=2020-01-03|title=Association of Medicaid Expansion With Enrollee Employment and Student Status in Michigan|journal=JAMA Network Open|language=en|volume=3|issue=1|pages=e1920316|doi=10.1001/jamanetworkopen.2019.20316|pmc=7042869|pmid=32003820|doi-access=free}}</ref><ref>{{Cite journal|last1=Hall|first1=Jean P.|last2=Shartzer|first2=Adele|last3=Kurth|first3=Noelle K.|last4=Thomas|first4=Kathleen C.|date=2018-07-19|title=Medicaid Expansion as an Employment Incentive Program for People With Disabilities|journal=American Journal of Public Health|volume=108|issue=9|pages=1235–1237|doi=10.2105/AJPH.2018.304536|issn=0090-0036|pmc=6085052|pmid=30024794}}</ref><ref>{{Cite journal|last1=Hall|first1=Jean P.|last2=Shartzer|first2=Adele|last3=Kurth|first3=Noelle K.|last4=Thomas|first4=Kathleen C.|date=2016-12-20|title=Effect of Medicaid Expansion on Workforce Participation for People With Disabilities|journal=American Journal of Public Health|volume=107|issue=2|pages=262–264|doi=10.2105/AJPH.2016.303543|issn=0090-0036|pmc=5227925|pmid=27997244}}</ref> A 2017 paper found that Medicaid expansion under the Affordable Care Act "reduced unpaid medical bills sent to collection by $3.4 billion in its first two years, prevented new delinquencies, and improved [[credit score]]s. Using data on credit offers and pricing, we document that improvements in households' financial health led to better terms for available credit valued at $520 million per year. We calculate that the financial benefits of Medicaid double when considering these indirect benefits in addition to the direct reduction in out-of-pocket expenditures."<ref>{{cite journal|last1=Brevoort|first1=Kenneth|last2=Grodzicki|first2=Daniel|last3=Hackmann|first3=Martin B|date=November 2017|title=Medicaid and Financial Health|url=https://www.nber.org/papers/w24002|journal=NBER Working Paper|series=Working Paper Series |publisher=National Bureau of Economic Research|pages=24002|doi=10.3386/w24002|doi-access=free}}</ref> Studies have found that Medicaid expansion reduced rates of poverty and severe [[Food security|food insecurity]] in certain states.<ref>{{cite journal|last1=Zewde|first1=Naomi|last2=Wimer|first2=Christopher|date=January 2019|title=Antipoverty Impact Of Medicaid Growing With State Expansions Over Time|journal=Health Affairs|volume=38|issue=1|pages=132–138|doi=10.1377/hlthaff.2018.05155|pmid=30615519|s2cid=58641724 }}</ref><ref>{{Cite journal|last=Himmelstein|first=Gracie|date=2019-07-18|title=Effect of the Affordable Care Act's Medicaid Expansions on Food Security, 2010–2016|journal=American Journal of Public Health|volume=109|issue=9|pages=e1–e6|doi=10.2105/AJPH.2019.305168|issn=0090-0036|pmc=6687269|pmid=31318597}}</ref> Studies on the implementation of work requirements for Medicaid in Arkansas found that it led to an increase in uninsured individuals, medical debt, and delays in seeking care and taking medications, without any significant impact on employment.<ref>{{Cite web|url=https://www.latimes.com/science/la-sci-arkansas-medicaid-work-requirements-backfire-20190619-story.html|title=Arkansas' Medicaid work requirement left people uninsured without boosting employment|last=Galewitz|first=Phil|website=[[Los Angeles Times]]|access-date=2019-06-22|date=June 19, 2019}}</ref><ref>{{Cite journal|last1=Sommers|first1=Benjamin D.|last2=Goldman|first2=Anna L.|last3=Blendon|first3=Robert J.|last4=Orav|first4=E. John|last5=Epstein|first5=Arnold M.|date=2019-06-19|title=Medicaid Work Requirements — Results from the First Year in Arkansas|journal=New England Journal of Medicine|volume=381|issue=11|pages=1073–1082|doi=10.1056/NEJMsr1901772|pmid=31216419|issn=0028-4793|doi-access=free}}</ref><ref>{{Cite journal|date=2020|title=Medicaid Work Requirements In Arkansas: Two-Year Impacts On Coverage, Employment, And Affordability Of Care|url= |journal=Health Affairs|doi=10.1377/hlthaff.2020.00538|last1=Sommers|first1=Benjamin D.|last2=Chen|first2=Lucy|last3=Blendon|first3=Robert J.|last4=Orav|first4=E. John|last5=Epstein|first5=Arnold M.|volume=39|issue=9|pages=1522–1530|pmid=32897784|pmc=7497731}}</ref> A 2021 study in the ''American Journal of Public Health'' found that Medicaid expansion in Louisiana led to reductions in [[medical debt]].<ref>{{Cite journal|last1=Callison|first1=Kevin|last2=Walker|first2=Brigham|date=2021|title=Medicaid Expansion and Medical Debt: Evidence From Louisiana, 2014–2019|journal=American Journal of Public Health|volume=111|issue=8|pages=e1–e7|doi=10.2105/AJPH.2021.306316 |pmc=8489609 |pmid=34213978|s2cid=235724057|issn=0090-0036}}</ref>

=== Political participation increase ===
A 2017 study found that Medicaid enrollment increases political participation (measured in terms of voter registration and turnout).<ref>{{cite journal|last1=Clinton|first1=Joshua D.|last2=Sances|first2=Michael W.|date=2 November 2017|title=The Politics of Policy: The Initial Mass Political Effects of Medicaid Expansion in the States|journal=American Political Science Review|volume=112|issue=1|pages=167–185|doi=10.1017/S0003055417000430|s2cid=96427012}}</ref>

=== Crime reduction ===
Studies have found that Medicaid expansion reduced crime. The proposed mechanisms for the reduction were that Medicaid increased the economic security of individuals and provided greater access to [[Substance abuse prevention|treatment for substance abuse]] or [[behavioral disorder]]s.<ref>{{Cite journal|last1=He|first1=Qiwei|last2=Barkowski|first2=Scott|date=2020|title=The effect of health insurance on crime: Evidence from the Affordable Care Act Medicaid expansion|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.3977|journal=Health Economics|language=en|volume=29|issue=3|pages=261–277|doi=10.1002/hec.3977|issn=1099-1050|pmid=31908077|s2cid=210042112}}</ref><ref>{{cite journal|last1=Wen|first1=Hefei|last2=Hockenberry|first2=Jason M.|last3=Cummings|first3=Janet R.|date=October 2017|title=The effect of Medicaid expansion on crime reduction: Evidence from HIFA-waiver expansions|journal=Journal of Public Economics|volume=154|pages=67–94|doi=10.1016/j.jpubeco.2017.09.001}}</ref> A 2022 study found that Medicaid eligibility during childhood reduced the likelihood of criminality during early adulthood.<ref>{{Cite journal |last1=Hendrix |first1=Logan |last2=Stock |first2=Wendy A. |date=2022 |title=Investing in Health and Public Safety: Childhood Medicaid Eligibility and Later Life Criminal Behavior |url=http://jhr.uwpress.org/content/early/2022/05/02/jhr.1119-10549R5 |journal=Journal of Human Resources |page=1119 |language=en |doi=10.3368/jhr.1119-10549R5 |s2cid=213273777 |issn=0022-166X}}</ref>

=== Oregon Medicaid health experiment and controversy ===
{{Main|Oregon Medicaid health experiment}}

In 2008, Oregon decided to hold a randomized lottery for the provision of Medicaid insurance in which 10,000 lower-income people eligible for Medicaid were chosen by a randomized system. The lottery enabled studies to accurately measure the impact of health insurance on an individual's health and eliminate potential selection bias in the population enrolling in Medicaid.

A sequence of two high-profile studies by a team from the [[Massachusetts Institute of Technology]] and the [[Harvard School of Public Health]]<ref>{{Cite journal|last1=Baicker|first1=Katherine|last2=Taubman|first2=Sarah L.|last3=Allen|first3=Heidi L.|last4=Bernstein|first4=Mira|last5=Gruber|first5=Jonathan H.|last6=Newhouse|first6=Joseph P.|last7=Schneider|first7=Eric C.|last8=Wright|first8=Bill J.|last9=Zaslavsky|first9=Alan M.|date=2013-05-02|title=The Oregon Experiment — Effects of Medicaid on Clinical Outcomes|journal=New England Journal of Medicine|language=en|volume=368|issue=18|pages=1713–1722|doi=10.1056/NEJMsa1212321|issn=0028-4793|pmc=3701298|pmid=23635051}}</ref> found that "Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years ," but did "increase use of health care services, raise rates of diabetes detection and management, lower rates of [[Depression (mood)|depression]], and reduce financial strain."

The study found that in the first year:<ref>{{cite web|url=http://journalistsresource.org/studies/society/health/oregon-health-insurance-experiment/|title=Oregon Health Insurance Experiment: Evidence from the First Year|last=Olver|first=Christopher|date=2011-07-11|website=journalistsresource.org}}</ref>

# Hospital use increased by 30% for those with insurance, with the length of hospital stays increasing by 30% and the number of procedures increasing by 45% for the population with insurance;
# Medicaid recipients proved more likely to seek preventive care. Women were 60% more likely to have [[Mammography|mammograms]] and recipients overall were 20% more likely to have their [[cholesterol]] checked;
# In terms of self-reported health outcomes, having insurance was associated with an increased probability of reporting one's health as "good ," "very good ," or "excellent"—overall, about 25% higher than the average;
# Those with insurance were about 10% less likely to report a diagnosis of depression.
#Patients with catastrophic health spending (with costs that were greater than 30% of income) dropped. 
#Medicaid patients had cut in half the probability of requiring loans or forgoing other bills to pay for medical costs.<ref>{{Cite news|url=https://www.economist.com/blogs/democracyinamerica/2013/05/medicaid|title=More study needed|date=2013-05-06|newspaper=The Economist|access-date=2017-06-27}}</ref>

The studies spurred a debate between proponents of expanding Medicaid coverage and fiscal conservatives challenging the value of this expansive government program.<ref>{{Cite web|last=Fung|first=Brian|date=2012-06-26|title=What Actually Happens When You Expand Medicaid, as Obamacare Does?|url=https://www.theatlantic.com/health/archive/2012/06/what-actually-happens-when-you-expand-medicaid-as-obamacare-does/258989/|access-date=2019-04-18|website=The Atlantic|language=en-US}}</ref><ref>{{Cite web|url=https://www.forbes.com/sites/theapothecary/2013/05/02/oregon-study-medicaid-had-no-significant-effect-on-health-outcomes-vs-being-uninsured/|title=Oregon Study: Medicaid 'Had No Significant Effect' On Health Outcomes vs. Being Uninsured|last=Roy|first=Avik|website=Forbes|language=en|access-date=2019-04-18}}</ref>