Review Article
Affordable Care ActThe Effects Of Medicaid Expansion Under The ACA: A Systematic Review
- 1. Olena Mazurenko is an assistant professor of health policy and management at Indiana University, in Indianapolis.
- 2. Casey P. Balio is a doctoral student in health policy and management at Indiana University, in Indianapolis.
- 3. Rajender Agarwal is director of the Center for Health Reform, in Dallas, Texas. At the time this work was done, he was a Business of Medicine MBA candidate at Indiana University’s Kelley School of Business, in Indianapolis.
- 4. Aaron E. Carroll is a professor of pediatrics at the Indiana University School of Medicine, in Indianapolis.
- 5. Nir Menachemi (nirmena@iu.edu) is a professor of health policy and management and chair of the Department of Health Policy and Management at Indiana University in Indianapolis.
Abstract
Expanding eligibility for Medicaid was a central goal of the Affordable Care Act (ACA), which continues to be debated and discussed at the state and federal levels as further reforms are considered. In an effort to provide a synthesis of the available research, we systematically reviewed the peer-reviewed scientific literature on the effects of Medicaid expansion on the original goals of the ACA. After analyzing seventy-seven published studies, we found that expansion was associated with increases in coverage, service use, quality of care, and Medicaid spending. Furthermore, very few studies reported that Medicaid expansion was associated with negative consequences, such as increased wait times for appointments—and those studies tended to use study designs not suited for determining cause and effect. Thus, there is evidence to document improvements in several areas of health care delivery following the ACA Medicaid expansion. We outline areas for future research that can further reduce current knowledge gaps.
