With political battles continuing over Medicaid expansion, a new study found states that expanded Medicaid saw greater reductions than non-expansion states in hospital admissions, length of stay and hospital costs for conditions that can be managed with ambulatory care.
States that expanded coverage to low-income adults under the Affordable Care Act saw a 3.5% reduction in annual "ambulatory-care sensitive" condition discharge rates, and a 3.1% drop in inpatient days in 2014 and 2015, according to the study published Monday in Health Affairs. Hospital costs dipped by nearly 3%.
The decline in discharge rates in expansion states was concentrated among chronic respiratory conditions, diabetes-related complications, and bacterial pneumonia.
The findings suggest Medicaid expansion could save money and lower preventable hospitalizations, the authors wrote.
The study comes out as Tuesday's gubernatorial elections in three conservative states may turn partly on how voters feel about Medicaid expansion, and as several other conservative states consider implementing it. Polls show Medicaid expansion is popular among both Democrats and Republicans. Last month, expansion advocates in Oklahoma filed enough petition signatures to get the issue on the ballot next November.
Meanwhile, the expansion and all other parts of the ACA could be erased if the 5th U.S. Circuit Court of Appeals declares President Barack Obama's signature law unconstitutional.
The new Health Affairs paper is consistent with a large and growing body of research showing that Medicaid expansion is associated with increased coverage, service use, quality of care and federal and state Medicaid spending. There are conflicting studies, however, about the impact on hospitalization rates.
"This study is another piece of evidence that Medicaid expansion gets people more care, so people with chronic conditions can stay out of the hospital," said Dr. Benjamin Sommers, a health policy professor at Harvard University. "We can probably stop arguing about whether expanding Medicaid helps people. It's pretty clear it does."
Still, Sommers said there is a need to study why Medicaid expansion's impact seems to vary by state and population group.
A separate study in Health Affairs on Monday found an urgent need for data sharing and integration between the medical, behavioral and social care systems that serve Medicaid patients who are frequent emergency department users.
Studying data on Medicaid patients from 2012 to 2015 in San Francisco, the researchers found that frequent ED users tend to be sicker than non-frequent users and have more behavioral health and social service needs. But services are often delivered in silos, without providers communicating or coordinating between the different service sectors.
"Behavioral health, medical health, and social services providers must share data to identify and address the needs of this population—which can range from poorly controlled diabetes to housing instability, and from addiction to unemployment—in an integrated, coordinated and comprehensive manner," the authors wrote.
On Tuesday, voters in Kentucky, Louisiana and Mississippi will weigh in on the future of Medicaid expansion, which polls show is popular among both Democrats and Republicans. The candidates in all three states have raised expansion as a major issue.
Kentucky's Republican Gov. Matt Bevin, who has threatened to end his state's expansion if the courts throw out his Medicaid work requirement, faces a Democrat, Andy Beshear, who promises to protect the expansion spearheaded by his father, former Gov. Steve Beshear.
In Louisiana, Democratic Gov. John Bel Edwards, who pushed through expansion in 2015, faces Republican Eddie Rispone, who wants to freeze enrollment and impose a work requirement.
In Mississippi, where the candidates are running for an open seat, Democrat Jim Hood supports expansion while Republican Tate Reeves opposes it.