Study: How Medicaid Expansion Affected Access, Wait Times

Mazurenko

Medicaid expansion following the ACA was associated with increases in coverage, service use, quality of care, and Medicaid spending, according to a new study.

In a systematic literature review, published in Health Affairs, lead study author Olena Mazurenko, MD, PhD, of Indiana University, and colleagues, analyzed 77 studies and conducted the systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Very few studies reported that Medicaid expansion was associated with negative consequences, such as increased wait times for appointments, according to the researchers.

“Thus, there is evidence to document improvements in several areas of healthcare delivery following the ACA Medicaid expansion,” says Mazurenko, who is assistant professor, Department of Health Policy and Management, Indiana University in Indianapolis.

The researchers observed significant differences in the likelihood of reporting an effect that was inconsistent with the ACA based on the study design. Specifically, studies with stronger designs (for example, experimental or quasi-experimental studies) did not differ from other studies (for example, cross-sectional or uncontrolled studies) with respect to the likelihood of reporting a relationship consistent with the ACA.

“However, study designs with weaker internal validity were significantly more likely to report an effect inconsistent with the ACA,” Mazurenko says. “For example, Chang-Yeon Kim reported a decrease in access to care based on cross-sectional data and using a study design not suited for attributing causality. Thus, our synthesis of results presented in the literature review focused exclusively on studies that used quasi-experimental designs.”

Based on the study, Mazurenko has three takeaways for healthcare executives:

• Current evidence shows that Medicaid expansion following the ACA was associated with increases in coverage, service use, quality of care, and Medicaid spending.
• Very few studies reported that Medicaid expansion was associated with negative consequences, such as increased wait times for appointments-and those studies tended to use study designs not suited for determining cause and effect.
• Relatively few studies examined the effects of the Medicaid expansion on health status.

“Managed care executives can learn from our study that the current best evidence on the ACA’s Medicaid expansion suggests that improvements in access to and quality of care, as well as to some degree in health, have occurred,” she says. “More research is needed to understand the impact of this major policy decision fully.”