Although there is still an ongoing debate in many states over whether or not to expand Medicaid, in the 33 states that have, unexpected benefits are starting to surface.

When the Patient Protection and Affordable Care Act (ACA) laid the framework for Medicaid Expansion, it allowed states to expand the income level needed to qualify for Medicaid. This gave a large number of Americans access to coverage. But it turns out this wasn’t the only benefit.

Increased likelihood to quit smoking

A University of Pittsburgh study showed low-income adults who gained coverage for the first time under Medicaid expansion were more likely to stop smoking cigarettes than those in states that did not expand the program.

The researchers found that 8.1% of low-income adults in expanded states reported recently quitting smoking, which is higher than the national average. Although there is likely no one reason why, this can be linked the former-smokers having more frequent primary care visits where their physicians are likely to deter them from smoking.

Since smoking accounts for 9% of health expenses in the U.S. annually, the increased number of quitters under Medicaid expansion could have a noticeable effect on healthcare spending in those states.

Decrease in crime rate

Ph.D. candidate Jacob Vogler proved states that have expanded Medicaid under the ACA experienced a 3.2% decrease in their annual rate of crime as compared to states that did not expand Medicaid.

The largest crime rate decreases were found in counties that saw the largest increases in insured rates after their Medicaid expansion. Additionally, out of the estimated 15 million individuals newly eligible for Medicaid through expansion, about 33%, or 5 million, had criminal records.

The study also found that violent crimes experienced a larger reduction than the average, falling by 4-5%. The data is still considered short-term, but the significance of Vogler’s findings should not be understated, especially when the average annual savings could amount to $13.6 billion nationally.

Reduction in medical debt

The Urban Institute found that while medical debt is falling nationally, the decline is much higher in states that have expanded Medicaid.

While 23.8% of Americans reported medical debt, the state-by-state range is large. Hawaii has the lowest percentage of residents with medical debt 5.9%, and Mississippi ranks highest with 37.4%. Hawaii was an early adopter of Medicaid expansion, while Mississippi has not expanded Medicaid under the ACA.

The study also highlighted that medical debt rates correlate strongly with uninsured rates. Medicaid is the key to reducing these debts, the authors concluded, because covered individuals aren’t responsible for paying large out-of-pocket costs the way that many with private insurance or no insurance at all are.

Two professors from University of Minnesota came to similar conclusions in their study of financial data on people who would be eligible for expanded Medicaid. They found that medical debt is down nearly 2 times as much in states that expanded Medicaid as compared to states that did not, and it is highest in many of the 17 states that have not expanded Medicaid.

The case for Medicaid expansion

These studies clearly show that while the aim of ACA Medicaid expansion was to decrease the number of uninsured Americans, it has also shown significant other health and societal benefits. Though their data is limited, researchers were able to prove that Medicaid expansion has statistically significant effects on the rates of smoking, crime, and medical debt in those states that chose to expand.

States still debating the expansion should also note the significant cost savings each benefit can provide. Medicaid-eligible state residents could also see a significant reduction in medical debt. Overall, while there are valid points on both sides of the Medicaid expansion argument, it turns out there are a few more positives than initially expected.


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Sean Kirschner

Sean is a Business Analyst at Softheon. His objective is to provide insight into the current state of the healthcare landscape through research on both business and policy. He is also responsible for assisting the research team through creating and maintaining research briefings on various industry topics. He earned his bachelor’s degree in economics from Boston College.

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