The Impact of Medicaid Expansion on the Quality of Care in the United States

Abstract

This paper explores the effects of Medicaid Expansion through the Affordable Care Act on the quality of healthcare in the United States. Historically, most research on Medicaid Expansion has focused on coverage rates, with very limited work done on understanding changes in quality outcomes. Given the medical community’s recent stance on the importance of measuring quality, this study analyzes publicly available Medicare data to understand how quality measures in eight broad outcome categories have changed as a result of Medicaid Expansion. We find that the provision certainly does have a significant impact on quality in Expansion states—even for non-Medicaid populations—with an improvement in patient survey results (0.0173 standard deviations above the mean) and a drop in readmissions particularly in lower-income hospitals, as well as a worsening of timeliness (0.143 standard deviations below the mean) concentrated in higher-income hospitals. The results demonstrate that within Expansion states, there is improved care coordination in lower-income hospitals, and a clear effect on higher-income hospitals which intuitively should not be affected with longer waiting times.