More Evidence Supports Closing the Medicaid Gap

When the ACA was approved in 2010, it was a game changer with extended eligibility requirements for the Medicaid program. A recent policy brief recommends supporting a Medicaid extension to the current eligibility to include full maternal health care coverage to both parents and adults without children with incomes below 138% FPL (federal poverty level). However, this is an optional recommendation and a state which does not choose to expand can draw their own line for coverage. This freedom of choice has caused certain states, such as Texas, to keep their eligibility for Medicaid for non-pregnant women as little 17% FPL. 

The study centered its argument around especially well-framed social factors such as prenatal care, maternal mortality, postpartum depression, infant mortality, infant health disparities, and racial disparities. Almost all of these outcomes have improved with Medicare expansion. Racial disparities are all too common, especially in the areas of maternal mortality and infant health. To focus on the effect Medicaid expansion has had on race, the study included a heat map of the population percentages of African Americans in each state. It is evident that the highest percentage of African Americans live in non-expansion states. Therefore, expansion in these largely Southern states would prove beneficial to reducing racial disparities among this population.

On the other hand, the study explained the benefits of expansion by comparing percentage decrease in uninsured rates. However, this metric by itself was misleading because the initial uninsured rate is needed for an accurate comparison. For example, Massachusetts and District of Columbia seem to be expansion states with the least percent decline in uninsured, but their uninsured rates were already significantly lower than the rest of the country. Essentially, the metric the authors used to present the benefits of expansion was ambiguous without adequate context. If relevant background information, such as a state’s previous insurance policies and incentives associated with expansion, was provided, it would help frame the findings to either be favorable towards expansion or expose the reasons for not expanding.

Overall, this article had some issues in data presentation that might have made their argument too vague, but other key points about social factors were pivotal in explaining the benefits of expansion. Regarding this, Texas, which has one of the lowest eligibility requirements at 17% FPL, and other states with similarly low eligibility requirements should consider expanding Medicaid further to reduce socioeconomic and racial disparities especially among women of childbearing potential. 

This Health Policy Journal Club review is written by Divya Chilukuri as part of our collaboration with the Health Policy Journal Club at Baylor College of Medicine where she is a medical student.

Key Findings

New research shows states that expand Medicaid improve the health of women of childbearing age: increasing access to preventive care, reducing adverse health outcomes before, during and after pregnancies, and reducing maternal mortality rates.

While more must be done, Medicaid expansion is an important means of addressing persistent racial disparities in maternal health and maternal mortality.

Better health for women of childbearing age also means better health for their infants. States that have expanded Medicaid under the Affordable Care Act saw a 50 percent greater reduction in infant mortality than non-expansion states.

The uninsured rate for women of childbearing age is nearly twice as high in states that have not expanded Medicaid compared to those that have expanded Medicaid (16 percent v. 9 percent). States with the highest uninsured rates for women of childbearing age are: Alabama, Alaska, Florida, Georgia, Idaho, Mississippi, Nevada, North Carolina, Oklahoma, South Carolina, Texas and Wyoming. Ten of these twelve states have not expanded Medicaid.

Searing, A and Ross, DC. Georgetown University Health Policy Institute. May 9, 2019.