Low-income Adults in Medicaid Expansion States Report Better Access to Health Care, GAO Report Finds

A new report by the U.S. Government Accountability Office (GAO) adds to the growing evidence that some states' failure to expand Medicaid is leaving low income adults with unmet health needs. Based on U.S. National Health Interview Survey (NHIS) data, the report focuses on access to care for low-income adults in states that have and have not expanded access to Medicaid.

“Insurance coverage and access to health care makes a significant difference for low-income adults across the U.S.,” says Janet Heinrich, DrPH, RN, FAAN, a research professor at the George Washington University Milken Institute School of Public Health.  Prior to joining the faculty at GWU, Heinrich served as senior advisor at the Center for Medicare and Medicaid Innovation (CMMI) of the Centers for Medicare & Medicaid Services (CMS).

The report used NHIS data from 2016, when 31 states (plus the District of Columbia) had capitalized on a provision in the Affordable Care Act that allows states to expand their Medicaid eligibility in order to cover more low-income people. Back then, 19 states had not expanded Medicaid. As of now, 34 states have adopted Medicaid expansion, three states are considering expansion, and 14 states have not adopted expansion.

“The GAO found that low-income adults in Medicaid Non-Expansion States were much worse off than low-income adults in Medicaid Expansion States,” Heinrich says.  “Removing financial barriers makes a considerable difference in addressing medical needs and reducing reports of fair or poor health.” 

The report includes NHIS estimates which show that over half of uninsured, low-income adults were male, over half were employed, and over half had incomes less than 100 percent of the federal poverty level. 

“This evidence of the positive effect of state Medicaid expansion on the health of low-income adults comes as the Administration announces a new Medicaid chief, Mary Mayhew, a former Maine health official who has criticized Medicaid expansion and sought to tighten eligibility requirements in traditional Medicaid,” Heinrich says. “She also supports the Trump administration’s encouragement of work requirements in Medicaid.  Clearly the Trump Administration is moving in the wrong direction!”