One team found a 23 percent increase in the diabetes diagnosis rate in expansion states. (Illustration: Thinkstock)

One of the big questions about the Affordable Care Act Medicaid expansion program has been whether expansion would do much to increase poor people’s access to health care, and whether any extra care received would improve poor people’s health.

Some expansion critics had suggested that uninsured poor people might be getting more care from free clinics than they could get through overburdened Medicaid providers, and that any additional care new Medicaid enrollees did get might not be high-value care, or might not do much to improve the new Medicaid enrollees’ overall level of health.

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The Office of the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services says in a new review of Medicaid expansion impact studies that the new Medicaid enrollees seem to be getting more care, and more high-value care.

ACA made provided federal money for states that agreed to make Medicaid available to childless adults who earn up to 138 percent of the federal poverty level. Some states rejected the money. Other states took the money and expanded their Medicaid programs starting in January 2014.

Another ACA provision, which expired in December 2014, required Medicaid programs to pay primary care providers about as much as traditional Medicare paid primary care providers. Officials had estimated that typical Medicaid plans were paying primary care doctors only about 60 percent of the Medicare rate.

The Health and Human Services planning office, which has published commentaries supporting ACA programs in the past, says in a section on primary care appointment availability that the Medicaid primary care pay parity provision seems to have stabilize Medicaid enrollees’ access to primary care.

One research team found that Medicaid enrollees were able to get primary care appointments about as quickly in mid-2014 as before Medicaid expansion took effect, and that the percentage of primary care providers who had appointments available for Medicaid patients increased to 55 percent, from 49 percent, the office says.

Another team found that primary care appointment availability increased to 66.4 percent, from 58.7 percent, the office says.

In another section, on the impact of Medicaid expansion on the amount of care delivered, the planning office says preventive services visit volume at community health centers increased 41 percent in expansion states in 2014 and just held steady in non-expansion states.

Apparently because of the increased use of preventive services in expansion states, the number of Medicaid enrollees with diabetes diagnoses increased 23 percent in the expansion states, and just 0.4 percent in the non-expansion states, the planning office says.

The percentage of low-income adults who said they had unmet care needs fell to 44.8 percent after expansion, from 55.3 percent pre-expansion, the office says.

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