Texas Coverage Gap Project

Health

The best evidence links coverage to fewer deaths and less depression. Short-term changes in physical measures such as blood pressure were not detected.

Fewer deaths among near-elderly low-income adults Strong design

Using linked Census and Social Security records, researchers found that expansion reduced annual mortality among low-income adults ages 55–64 by 0.132 percentage points, a 9.4% reduction, and the effect grew over time.1

Lower all-cause mortality in expansion counties Strong design

A county-level study estimated 11.36 fewer deaths per 100,000 adults ages 20–64 (3.6%), or about one death averted per 310 people newly covered.2 Earlier state expansions in New York, Maine, and Arizona were associated with about 6% lower adult mortality.3

Limits: Other researchers argue that available data cannot reliably detect mortality effects from the ACA expansions. One study found no significant effect, with wide uncertainty.4

Less depression; more diabetes detection; no 2-year change in blood pressure or cholesterol Strong design

In Oregon's lottery, a randomized experiment, Medicaid coverage reduced positive depression screens by 9.15 percentage points (about 30%) and increased diabetes diagnosis and treatment.5

Limits: No significant changes in blood pressure, cholesterol, or average blood sugar (HbA1c) were detected within two years. The study covered one state and lacked power to detect small changes.

Better regular care for chronic conditions Association

Compared with Texas, low-income adults in Kentucky and Arkansas who gained coverage were 41 percentage points more likely to have a usual source of care, and those with chronic conditions were 56 points more likely to get regular care for them.6

Limits: Survey-based comparison of three states; not randomized.

Opioid treatment and overdose deaths Association

Expansion was associated with about 6% fewer total opioid overdose deaths and more people treated with buprenorphine.7

Limits: Deaths involving methadone rose in the same study. These are associations.

Emergency department use rose Strong design

In Oregon, coverage increased emergency department visits by about 40% over two years.8 A three-state survey study found the opposite pattern.6 This site does not claim that expansion reduces ER visits.

Sources for this page

  1. Miller, Johnson, Wherry, 'Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data', QJE 136(3):1783-1829, doi:10.1093/qje/qjab004 (2021). https://academic.oup.com/qje/article-abstract/136/3/1783/6124639 [evidence H1]
  2. Borgschulte & Vogler, 'Did the ACA Medicaid expansion save lives?' J Health Econ 72:102333, doi:10.1016/j.jhealeco.2020.102333 (2020). https://doi.org/10.1016/j.jhealeco.2020.102333 [evidence H2]
  3. Sommers, Baicker, Epstein, NEJM 2012;367:1025-34, doi:10.1056/NEJMsa1202099 (2012). https://www.nejm.org/doi/full/10.1056/nejmsa1202099 [evidence H3]
  4. Black, Hollingsworth, Nunes, Simon, NBER w25568 'The Effect of Health Insurance on Mortality: Power Analysis...' (2019 (rev.)). https://econpapers.repec.org/RePEc:nbr:nberwo:25568 [evidence H4]
  5. Baicker et al., 'The Oregon Experiment', NEJM 2013;368:1713-22, doi:10.1056/NEJMsa1212321 (2013-05-02). https://www.nejm.org/doi/full/10.1056/NEJMsa1212321 [evidence H5]
  6. Sommers, Maylone, Blendon, Orav, Epstein, Health Affairs 2017, doi:10.1377/hlthaff.2017.0293 (2017-05). https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0293 [evidence H6]
  7. Kravitz-Wirtz et al., JAMA Netw Open 2020;3(1):e1919066; Saloner et al., JAMA Netw Open 2018;1(4):e181588 (2020-01; 2018). https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2758476 [evidence H7]
  8. Taubman et al., Science 2014, doi:10.1126/science.1246183; Finkelstein et al., NEJM 2016, doi:10.1056/NEJMp1609533 (2014; 2016). https://www.nejm.org/doi/full/10.1056/NEJMp1609533 [evidence H8]

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