Report: The Importance of Health Coverage

why is health insurance important?

Today, approximately 90 percent of the us. uu. residents have health insurance with significant gains in health coverage in the last five years. Health insurance makes it easier to access care and is associated with lower mortality rates, better health outcomes, and higher productivity. Despite recent advances, more than 28 million people still lack coverage, putting their physical, mental, and financial health at risk.

Reading: What is health insurance and why is it important

Meaningful health care coverage is essential to living a productive, safe and healthy life. U.S. Residents obtain health coverage from a variety of public and private sources, such as through their employers or direct purchase in the individual marketplace (private sources), as well as through Veterans Affairs, Medicare, or Medicaid programs (private sources). public).

The number of people with health insurance has increased significantly in recent years, with nearly 20 million people newly insured. Most of these individuals were able to enroll in coverage offered through the Medicaid program, their employer, or the individual marketplace as a result of the coverage programs and insurance marketplace reforms authorized by the Affordable Care Act (ACA).

impact of coverage

enrolling in coverage supports the health and well-being of individuals and communities. studies confirm that coverage improves access to care; supports positive health outcomes, including a person’s sense of their own health and well-being; encourages the proper use of health care resources; and reduces financial pressure on individuals, families, and communities. a list of resources can be found on page 4.

in particular, recent studies evaluating changes in states that expanded Medicaid compared to those that did not highlight the value of coverage.1

coverage improves access to care

Adults enrolled in Medicaid are five times more likely to have regular sources of care and four times more likely to receive preventive care services than people without coverage. Children with Medicaid coverage are four times more likely to have regular sources of care and two to three times more likely to receive preventive care services than children without insurance.2 In addition, low-income children with parents covered by Medicaid are more likely to receive care-child visits than those with uninsured parents.3

a higher proportion of people in Medicaid expansion states have a personal doctor than those in non-expansion states.4

People with coverage are more likely to gain access to prescription drug therapies. people in states that expanded Medicaid have better access to medications for diabetes and asthma, birth control, and cardiovascular medications.5,6,7

People with coverage are more likely to get early diagnosis and treatment, which can ultimately help improve health outcomes.8

People in expanding Medicaid states have higher rates higher rates of diabetes diagnoses than those in states that did not have not expand.9

receive more timely and therefore less complicated care for five common surgical conditions.10

Medicaid expansion is associated with access to timely diagnosis and treatment for cancer.11,12,13,14,15

Coverage improves access to behavioral health and substance use disorder treatment.16

Young adults with mental illness who have coverage have a higher rate of monthly outpatient visits than mental health than those without coverage.17

in ohio, people who become eligible and enroll in medicaid reported better access to mental health services after enrollment,18 and in connecticut, a third of people enrolled in expanded medicaid use their Coverage for care related to mental health and substance use disorder. 19

Coverage is critical to efforts to combat the opioid epidemic.20 In West Virginia, the expansion of Medicaid increased access to opioid use disorder (OUD) treatment. by 2016, 75% of oud medicaid enrollees filled prescriptions for medication treatment.21

Coverage lowers cost barriers to accessing care. fewer people in states that expanded medicaid report that cost is a barrier to care than those in states that did not expand medicaid,22 and fewer people in expanding states report skipping their medications because of cost.23 specifically in rural areas, people were 8% less likely to report cost as a barrier to care in Medicaid expansion states.24

cover is associated with better health outcomes

Coverage expansion is associated with declines in mortality.25 After massachusetts implemented coverage expansion through both Medicaid and private coverage, the all-cause mortality rate in status was significantly reduced.26 Medicaid expansion is specifically associated with lower cardiovascular mortality.27

More people in expanding states quit smoking, according to Medicaid coverage for evidence-based preventive care and smoking cessation services.28,29

a study of oregon’s earlier expansion found that people who became eligible for medicaid experienced lower rates of depression than those who didn’t.30

People with coverage report a greater sense of well-being, with an increase in people reporting excellent health after states expanded Medicaid.31,32

coverage supports appropriate use of health care

covering can help direct people to the most appropriate place of care. young adults who were able to stay on their parents’ health plan experienced declines in non-emergency emergency department (ed) visits.33 expanding populations in some states also experienced declines in ed visits and an increase in outpatient visits.34,35,36

Coverage makes it easy to use preventive care and manage chronic conditions. people in expanding states saw significant increases in diabetes screening, glucose testing among patients with diabetes, and regular care for chronic conditions.37

coverage improves individual, family and community well-being

Hospitals, particularly rural hospitals, in states that expanded Medicaid experienced better financial performance and were less likely to close.38,39

Medicaid expansion is associated with a decrease in violent and property crime, and associated government spending to reduce crime.40

Coverage reduces the financial burden and risk for individuals and families by reducing annual out-of-pocket expenses41 and essentially eliminating catastrophic expenses.42

in ohio, people who became eligible and enrolled in medicaid reported that enrollment made it easier to work and find work.43

In Montana, Medicaid expansion is estimated to create 5,000 jobs annually between 2018 and 2020, generating approximately $270 million in personal income each year.44

in michigan, enrolling in medicaid after medicaid expansion was found to be associated with better financial health, including a reduction in unpaid medical bills. Members with the greatest medical needs, such as chronic disease diagnoses, saw the greatest improvement in their financial health.45

many usa residents remain uninsured

Despite these hedge gains, almost 28 million u.s. residents remain uninsured. however, the proportion of people without health insurance varies dramatically across states, from a high of 17.7% in texas to a low of 2.8% in massachusetts.46 insurance status also varies by race and national origin ethnic. for example, Hispanics have disproportionately higher rates of being uninsured than non-Hispanic whites.47

Impact of the uninsured on the health system

the high rate of uninsured people puts pressure on the health care system in general. the uninsured put off needed care and rely more on hospital emergency departments, resulting in scarce resources being directed to treating conditions that often could have been prevented or managed in a lower-cost setting. Being uninsured also has serious financial implications for individuals, communities, and the health care system.

While all providers offer some level of charity care, it is insufficient to fully meet the needs of the uninsured. in 2017, hospitals provided $38.4 billion in unpaid care to patients. However, hospitals also absorbed an additional $76.8 billion in Medicare and Medicaid underpayments, and face additional funding reductions through cuts in Medicare and Medicaid hospital disproportionate share programs. these factors dramatically reduce the resources available for hospitals to provide charity care.48

resources

Antonisse, Larisa, et al., “The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review,” Kaiser Family Foundation, August 2019.

U.S. Health Insurance Plans, “The Value of Medicaid: Providing Access to Preventive Health Care and Services,” April 2018.

Venkataramani, Haddock, and Roberts, “Indirect Effects of Adult Medicaid Expansions on Children’s Use of Preventive Services,” Pediatrics, December 2017.

Simon, Soni, and Cawley, “The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of ACA Medicaid Expansions,” Journal of Policy Management and Analysis, 2017.

Ghosh, Simon, and Sommers, “The Effect of State Medicaid Expansions on Prescription Drug Use: Evidence from the Affordable Care Act,” National Bureau of Economic Research Working Paper Series, January 2017 .

myerson, lu, tonnu-mihara, and huang, “Medicaid Eligibility Expansions May Address Gaps in Access to Diabetes Medicines,” Health Matters, Aug 2018.

Connecticut Health Foundation, “Faces of Husky D: The Impact of Connecticut’s Medicaid Expansion,” May 2018.

Antonisse, Larisa, et al., “The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review,” Kaiser Family Foundation, August 2019.

Kaufman, Chen, et.al., “Increase in Newly Identified Diabetes Among Medicaid Patients in 2014 Within Medicaid Expansion States Under the Affordable Care Act,” Diabetes Care, May 2015 .

Loehrer, Chang, Scott, et al., “Partnering Affordable Care Act Medicaid Expansion with Access and Quality of Care for Surgical Conditions,” Jama Surgery, March 2018.

Smith, Anna and Nickels, Amanda, “Impact of the Affordable Care Act on the State’s Early Diagnosis and Treatment for Women With Ovarian Cancer,” Journal of Clinical Oncology, June 2019.

adamson, blythe j. S., et al., “Affordable Care Act (ACA) Medicaid Expansion Impact on Racial Disparities in Time to Cancer Treatment,” ASCO Annual Meeting/Journal of Clinical Oncology, June 2019.

Mesquita-Neto, Jose, et al., “Disparities in Access to Cancer Surgery After Medicaid Expansion,” The American Journal of Surgery, June 2019.

gan, tong et al., “Impact of the Affordable Care Act on Colorectal Cancer Detection, Incidence, and Survival in Kentucky,” Journal of the American College of Surgeons (Vol. 228, No. 4), April of 2019.

ajkay, bhutiani, et al., “early impact of medicaid expansion and quality of breast cancer care in kentucky,” journal of the american college of surgeons, april 2018.

Antonisse, Larisa, et al., “The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review,” Kaiser Family Foundation, August 2019.

Kozloff and Sommers, “Insurance Coverage and Health Outcomes in Young Adults with Mental Illness Following the Affordable Care Act’s Dependent Coverage Expansion,” Journal of Clinical Psychiatry, July/August 2017.

the ohio department of medicaid, “evaluation of ohio medicaid group viii: a report to the ohio general assembly”, august 2018.

Connecticut Health Foundation, “Faces of Husky D: The Impact of Connecticut’s Medicaid Expansion,” May 2018.

Antonisse, Larisa, et al., “The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review,” Kaiser Family Foundation, August 2019.

Saloner, Brendan, et al., “The Opioid Crisis Health Affordable Care Act: Evidence from West Virginia,” Health Affairs (Vol. 38, No. 4), April 2019.

Courtemanche, Marton, et.al., “Early Effects of the Affordable Care Act on Access to Health Care, Risky Health Behaviors, and Self-Assessed Health,” National Office of Health Working Paper Series economic research, March 2017.

Sommers, Blendon, et.al., “Changes in Utilization and Health Among Low-Income Adults Following Medicaid Expansion or Expanded Private Insurance,” Jama Internal Medicine, Aug 2016.

Wehby, George, et al., “Effects of the Patient Protection and Affordable Care Act on Coverage and Access to Care in Metropolitan Versus Non-Metropolitan Areas Through 2016,” Rupri Center for Health Analysis rural health policies, August 2019.

Miller, Sarah, et al., “Medicaid and Mortality: New Linked Survey Evidence and Administrative Date,” National Bureau of Economic Research, July 2019.

Sommers, Long, and Baicker, “Mortality Changes After Massachusetts Health Care Reform,” Annals of Internal Medicine, 2014.

khatana, sameed a. m., et al., “Association of Medicaid Expansion with Cardiovascular Mortality,” Jama Cardiology, June 2019.

koma, donohue, barry, et al. “Medicaid Coverage Expansions and Cigarette Smoking Cessation Among Low-Income Adults,” December 2017.

Antonisse, Larisa, et al., “The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review,” Kaiser Family Foundation, August 2019.

Baicker, Taubman, et.al., “The Oregon Experiment: Effects of Medicaid on Clinical Outcomes,” New England Journal of Medicine, May 2013.

Sommers, Blendon, et.al., “Changes in Utilization and Health Among Low-Income Adults Following Medicaid Expansion or Expanded Private Insurance,” Jama Internal Medicine, Aug 2016.

Antonisse, Larisa, et al., “The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review,” Kaiser Family Foundation, August 2019.

antwi, moriya, et. Alabama. “Changes in Emergency Department Use Among Young Adults Following the Provision of Dependent Coverage of the Patient Protection and Affordable Care Act,” Annals of Emergency Medicine, June 2015.

Sommers, Blendon, et.al., “Changes in Utilization and Health Among Low-Income Adults Following Medicaid Expansion or Expanded Private Insurance,” Jama Internal Medicine, Aug 2016.

the ohio department of medicaid, “evaluation of ohio medicaid group viii: a report to the ohio general assembly”, august 2018.

Connecticut Health Foundation, “Faces of Husky D: The Impact of Connecticut’s Medicaid Expansion,” May 2018.

Sommers, Blendon, et.al., “Changes in Utilization and Health Among Low-Income Adults Following Medicaid Expansion or Expanded Private Insurance,” Jama Internal Medicine, Aug 2016.

lindrooth, perraillon, hardy, and tung, “Understanding the Relationship Between Medicaid Expansions and Hospital Closures,” Health Matters, Jan 2018.

us government accountability office. USA, “Rural Hospital Closures: Number and Characteristics of Affected Hospitals and Contributing Factors,” August 2018.

Vogler, “Access to Health Care and Criminal Behavior: Short-Term Evidence from ICA Medicaid Expansions,” University of Illinois at Urbana-Champaign, September 2017.

Sommers, Long, and Baicker, “Mortality Changes After Massachusetts Health Care Reform,” Annals of Internal Medicine, 2014.

Baicker, Taubman, et.al., “The Oregon Experiment: Effects of Medicaid on Clinical Outcomes,” New England Journal of Medicine, May 2013.

the ohio department of medicaid, “evaluation of ohio medicaid group viii: a report to the ohio general assembly”, august 2018.

ward and bridge, “the economic impact of medicaid expansion in montana,” office of business and economic research, university of montana, april 2018.

Miller, et al., “The Expansion of ICA Medicaid in Michigan and Financial Health,” National Bureau of Economic Research, September 2018.

U.S. Census Bureau, 2018 American Community Survey 1-year estimates.

kaiser family foundation, “key facts about the uninsured population”, december 2018.

aha graphics book, 2017.

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