Ohio legislators have taken Medicaid expansion out of the budget, but keep talking about it. That’s good, because expanding Medicaid would be good for Ohio and good for Ohioans. In this issue brief, we look at studies of Medicaid quality.
Medicaid helps Ohioans gain access to doctors
A national study found uninsured people have much greater difficulty gaining access to needed care than those with Medicaid. The 2008 Ohio family health survey found that in Ohio, uninsured people were three times as likely to report lack of needed care than those with Medicaid coverage; the same share reported delays in obtaining the care they needed. 
Preventive care can improve lives
Medicaid provides access to preventive and regular care, which reduces suffering and death rates of chronic illness. Not only can screenings and precautionary steps often prevent onset of disease (e.g., breast cancer, diabetes, and cardiovascular disease) but early diagnosis and treatment can significantly increase chances of leading a healthy and productive life. A study of Medicaid patients found expansions of Medicaid eligibility in three states were associated with a significant decrease in mortality during a 5-year follow-up period, as compared with neighboring states without Medicaid expansions. Mortality reductions were greatest among adults between the ages of 35 and 64 years, minorities, and residents of poor counties. The estimated decrease in mortality was 6.1 percent.
Preventive care is long term, but provides short-term benefits too
A recent, limited study of Oregon’s expansion of Medicaid coverage sheds light on the potential beneficial effects of Medicaid expansion, particularly with mental illness. Even on a short-term (two-year) basis, access to Medicaid was found to increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain. These benefits occurred with no negative effects, such as increases in emergency-room use.
Ohio Medicaid gets high marks
The relative strength of Ohio’s program is shown by a 50-state study released in early May 2013. The report compared the quality of hospital care between patients with Medicaid and those with private insurance by studying three medical conditions. While it found substantial variation in Medicaid outcomes across the states, the report found
only small overall differences between Medicaid and private pay. For Ohio, the study found no difference between Medicaid and private pay for two conditions and only a 1 percentage
point difference for the third. The study found that Ohio’s scores were always above the national Medicaid average.
Medicaid expansion offers public health benefits
The public health benefits of expanded Medicaid translate directly to public safety and security. Access to care reduces the spread of disease by providing a cure or reducing infectiousness. For example, continuous and comprehensive treatment of HIV not only improves the health of the individual, but also reduces the likelihood of transmitting the virus by 96 percent.
Medicaid expansion protects health care access in rural areas
The federal Affordable Care Act incrementally reduces federal payments to hospitals (known as disproportionate share hospital funds, or DSH), anticipating that increased access to both Medicaid and private insurance will reduce the amount of uncompensated care that hospitals provide. Thus, hospitals in states with limited Medicaid coverage will face severe deficits as they continue to treat a high volume of uninsured patients. Without federal reimbursements for this care, hospitals will pass costs onto covered private-insurance patients; small hospitals (e.g., in rural areas) will not be able to offset these costs, and may be forced to close, leaving entire communities without access to care. According to a new rule governing the funding of DSH published by the Center for Medicare and Medicaid, our state’s safety net hospitals could face more than $23.4 million in cuts in 2014 to DSH funds. The cuts will grow deeper in the years that follow; by 2018, DSH cuts will total 40 percent nationally.
 Nakela Cook et al. “Access to Specialty Care and Medical Care Services in Community Health Centers.” Health Affairs. Volume 26, no 5 (2007): 1459-1468 http://content.healthaffairs.org/content/26/5/1459/T2.large.jpg.
 William Hayes, Testimony to the Ohio Senate Subcommittee on Medicaid Finance, May 7, 2013 at http://bit.ly/10uhmlv.
 Dr. Benjamin D. Sommers, Dr. Katherine Baicker & Dr. Arnold M. Epstein, Mortality and access to care among adults after state Medicaid expansion,” The New England Journal of Medicine (September 13, 2012) at http://bit.ly/LTcBeF.
 “Our estimate of a 6.1% reduction in the relative risk of death among adults is similar to the 8.5% and 5.1% population-level reductions in infant and child mortality, respectively, as estimated in analyses of Medicaid expansions in the 1980s. Our results correspond to 2,840 deaths prevented per year in states with Medicaid expansions, in which 500,000 adults acquired coverage. This finding suggests that 176 additional adults would need to be covered by Medicaid in order to prevent 1 death per year.” – see Sommers, Baicker & Epstein, Op.Cit.
 Dr. Katherine Baicker et.al, The Oregon Experiment: Effects of Medicaid on Clinical Outcomes, The New England Journal of Medicine (May 2, 2013) at http://bit.ly/11CbFcw.
 William Hayes, Op.Cit., (drawing on Joel S. Weissman, Christine Vogeli, and Douglas E. Levy. “The Quality of Hospital Care for Medicaid and Private Pay Patients.” Medical Care. May 2013; 51:389-395.)
 Myron S. Cohen et al, Prevention of HIV-1 Infection with Early Antiretroviral Therapy, The New England Journal of Medicine (August 11, 2011) at www.nejm.org/doi/full/10.1056/NEJMoa1105243.
 Hospitals are required by law to stabilize any patient in need, regardless of ability to pay.
 Harvard Law School Center for Health Law & Policy Innovation, Expanding Medicaid under the Affordable Care Act: Where do States Stand Today? at http://hvrd.me/QEndow.
 Centers for Medicare and Medicaid Services, Details for: Medicaid state disproportionate share hospital allotment reductions proposed rule http://go.cms.gov/17XSLvF.