Comparing State Decisions on Medicaid Expansion and Their Impact on Low-Income Populations, Phase 4


This survey, the fourth in a series, will assess the outcomes of different approaches to the Affordable Care Act’s Medicaid expansion. It will examine changes in low-income adults’ health insurance coverage and access to care in three Southern states: Kentucky, which expanded Medicaid consistent with the law; Arkansas, which took an alternative approach to expansion; and Texas, which has declined to expand. So far, the surveys have found that state policy decisions significantly affect enrollment, uninsured rates, and access to care. Most recently, the 2015 survey found significant increases in the use of preventive and chronic disease care, reported health care quality, and reductions in emergency department use in Kentucky and Arkansas relative to Texas. In this phase, the project team will conduct follow-up surveys in Arkansas, Kentucky, and Texas with samples of 1,000 adults whose income makes them eligible for Medicaid under the health reform law. The team will compare the new survey responses with those from 2013, 2014, and 2015 to measure change in peoples’ experiences over time; it will also ascertain differences in outcomes by individuals’ demographic profile. The survey provides data on the following measures: cost-related barriers to care; problems paying medical bills; use of preventive, ambulatory, emergency, and hospital services; and self-reported health status, depression, and care of health problems. This project will provide federal and state policymakers with evidence on the effects of different state approaches to Medicaid expansion, as well as other ACA policies like outreach and enrollment assistance. With state legislators and members of Congress likely to focus greater attention on Medicaid and the value it provides to its enrollees in 2017, the findings will provide an empirical basis for informed decision-making.

Grant Details

Grantee Organization:
Brigham and Women's Hospital, Inc.
Principal Investigator:
Benjamin Sommers, M.D., Ph.D.
Award Amount:
Approval Date:
July 13, 2016

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