Medicaid Medicaid expansion wasone of the fundamental ways the ACA attempted to improve insurancecoverage—and through it, health care access—for Americans. (Image:Shutterstock)

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A new review of research on Medicaid expansion, a key element of theAffordable Care Act (ACA), has found the vast majority of studiesshow positive effects from the expansion. The study, by theKaiser Family Foundation (KFF), reviewedfindings from 404 studies since 2014, including 80 new studiesconducted since KFF's last literature review.

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Medicaid expansion was one of the fundamental ways the ACAattempted to improve insurance coverage—and through it, health careaccess—for Americans. Not surprisingly, poorer Americans found thecost of health care a barrier to accessing care. The Medicaidexpansion raised the income limits for the program, which is run asa federal/state partnership. This allowed more Americans toparticipate in government-funded Medicaid insurance programs andgave states more financial resources for their programs.

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Related: ACA, Medicaid expansion improved cancer treatmentaccess

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A Supreme Court ruling in 2012 gave states the ability toopt-out of the ACA's Medicaid expansion, and 14 states at that time decided to opt out. Overtime, the generally positive effects of Medicaid expansion have ledsome states to reconsider their decisions to opt-out of theexpanded program.

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Five areas see clearly positive results

The new review looked at eight general areas of outcomesaffected by Medicaid expansion. Of those, five areas show clearlypositive results. Access and utilization of care, for example, wasan area found to have positive outcomes due to Medicaid expansionin 115 studies. In 30 studies, the expansion was found to have nodifference or mixed findings. Zero studies were classified asshowing negative effects on access and utilization due to Medicaidexpansion.

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The positive/mixed/negative numbers were similar in other areas:insurance coverage had 138 positive, 6 mixed, and zero negativestudies. Studies finding positive outcomes in payer mix (feweruninsured patients and more Medicaid patients seen in ERs, forexample) were listed at 71 positive, 2 mixed, and zero negative.The results for studies looking at health care affordability andfinancial security were 50 positive studies, six mixed, and zeronegative. Studies finding positive effects for state economies dueto Medicaid expansion were listed at 20, with zero mixed andnegative studies.

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Possible trouble areas: provider capacity and positive healthoutcomes

Two areas had more mixed results in the KFF review: providercapacity (16 positive, 19 mixed, 2 negative studies) and studiesabout positive health outcomes (nine positive, six mixed, twonegative.)

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In the area of provider capacity, the study said that capacitywas found to be increased in some studies, but noted that mixedfindings in the majority of studies may reflect limitedavailability of providers in some areas, including specialists. Themixed or negative findings were more likely to be from earlierstudies, the report added.

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Although the majority of studies on Medicare expansion andhealth outcomes listed positive results (9), a relatively highnumber of the studies had mixed results (6), with 2 studies showingnegative outcomes. "Some studies did not find an associationbetween Medicaid expansion and quality outcomes," the review said."Many of these studies focused on very narrow population groupsand/or found a link between expansion and improvements in qualityof care for some of the patient/population groups studied."

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