Financial “protection” from catastrophic healthcare expenses improved dramatically thanks to the Medicaid expansion under the Affordable Care Act, a new analysis shows.

The report in Friday’s JAMA Network Open comes as more states benefit from the expansion of Medicaid benefits under the ACA and supporters of the law are working on behalf of ballot measures that would bring such coverage to more Americans.

“Implementation of the ACA was associated with 31% lower odds of catastrophic health expenditures,” according to researchers that included Dr. Charles Liu of Stanford University’s department of surgery, writing in the Feb. 28 JAMA Network Open. “Financial protection gains were greatest in lowest-income patients targeted by Medicaid expansion, who experienced 30% lower out-of-pocket spending and 39% lower odds of catastrophic expenditures.”

To reach their conclusion, researchers examined more than 6,200 adult patients hospitalized or treated in the emergency room with traumatic injuries, analyzing health use and related expenditures drawn from the Medical Expenditure Panel Survey from January 2010 through 2017. The ACA was signed into law by President Obama 10 years ago and millions of Americans began to benefit from expanded Medicaid coverage in 2014. 

Still, healthcare expenses are increasingly a financial hardship for families with “1 in 4 U.S. adults aged 18 to 64 years reported their household had problems paying medical bills, and 60% of these adults reported a household member (in 2015) had delayed needed care because of cost,” researchers wrote in JAMA Network Open.

Only 14 states have yet to expand Medicaid under the ACA. Ballot initiatives are now in the works to bring Medicaid expansion to at least two more states as early as next year.

The hope by supporters of Medicaid expansion is that voters in Missouri and Oklahoma will follow the lead of successful 2018 ballot initiatives in Nebraska, Idaho and Utah. Those states, like Maine in 2017, bypassed Republican governors and legislatures to expand Medicaid by public referendum.

The 14 holdout states that remain have already missed out on generous federal funding of the Medicaid expansion. From 2014 through 2016, the ACA’s Medicaid expansion population was funded 100% with federal dollars. The federal government still picks up 90% or more of Medicaid expansion through 2020. It’s a better deal than before the ACA, when Medicaid programs were funded via a much less generous split between state and federal tax dollars.

Such expansion has been a boon to doctors, hospitals and health insurers like Anthem, Centene, UnitedHealth Group and CVS Health’s Aetna health insurance unit given these private insurers generally administer most Medicaid benefits in the U.S.

“The implementation of the ACA was associated with improved financial protection for U.S. adults with traumatic injury, especially lowest-income individuals targeted by the law’s Medicaid expansions,” researchers wrote in the Feb. 28 JAMA Network Open. “Despite these gains, injured patients remain at risk of financial strain.”

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ACA’s Medicaid Expansion Reduced Catastrophic Health Expenses – Forbes