State grades improve after ACA coverage expansions, more work needed

Two years after the Patient Protection and Affordable Care Act’s (ACA) major coverage expansions, fewer Americans lacked health insurance in every state and people benefitted from better quality and safer health care, according to recent research from the Commonwealth Fund. The State Health System Scorecard found that the states that expanded Medicaid, such as Arkansas, California, Kentucky, and Washington, made some of the biggest strides between 2013 and 2015 in covering people and ensuring they are able to get the care they need.

The study found that:

• The uninsured rate among low-income working-age adults dropped an average of 14.1 percentage points in states that expanded Medicaid, compared to 8.9 points in nonexpansion states.
• The percentage of low-income adults who said they went without care because of its cost dropped an average of 5.5 points in expansion states compared to 2.3 points in nonexpansion states. Likewise, the share who lacked a regular health care provider dropped an average of 2.7 points in expansion states, compared to 1.0 points in nonexpansion states.
• Kentucky, the state with the biggest decline in uninsured working-age adults, saw the share of adults who said they went without care because of costs drop by 7 percentage points—more than any other state. Arkansas and Oregon were close behind, each seeing a five-point drop.

“The scorecard gives us a comprehensive picture of how states are doing on crucial aspects of health care, allowing us to see how things look now compared to the years before the major provisions of the ACA were implemented,” said Commonwealth Fund president David Blumenthal. “It’s clear that states, especially those that have expanded Medicaid, have made substantial progress ensuring that their residents have health insurance, and millions are better able to get the health care they need since the law was passed. Any plan to repeal or amend the ACA must hold on to those gains.”

State rankings. The Scorecard ranks the health care system in every state and the District of Columbia based on 44 indicators of health care access, quality, cost, and outcomes. Vermont is the top-ranked state overall, followed by Minnesota, Hawaii, Rhode Island, and Massachusetts. Lowest-ranked are Arkansas, Louisiana, Oklahoma, and Mississippi. California climbed the most in the rankings between 2013 and 2015, from 26th to 14th. Colorado, Kentucky, New York, and Washington also made big jumps. Kentucky improved on 21 scorecard indicators, more than any other state.


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