CHICAGO U.S. states that opt to expand Medicaid under President Barack Obama's Affordable Care Act (ACA) can expect to enroll new patients who are younger, thinner, healthier, less depressed and more likely to be white than those now covered by Medicaid, U.S. researchers said on Monday.
The latest findings add to a growing picture of the incoming class of Medicaid enrollees under the ACA, which gives states the option to expand their Medicaid rolls to include previously ineligible low-income adults.
Medicaid expansion is expected to add more than 10 million people to the program, which has traditionally covered poor children, the elderly, pregnant women, the disabled and some parents.
Under Obama's signature healthcare law, the federal government will cover 100 percent of the cost of Medicaid expansion for the first three years and 90 percent after that, but many states have decided against expansion, often citing the cost of covering these new, previously uninsured individuals.
"There has been a lot of debate about how expensive the Medicaid expansion would be, and until now, it hadn't been clear which Americans had the potential to benefit from the added healthcare coverage in states that participate," said Dr Tammy Chang of the University of Michigan Medical School, whose study appears in the Annals of Family Medicine.
As of August 1, 23 states and Washington had accepted the expansion, while 21 states had turned it down, according to consultants Avalere Health. A 2012 U.S. Supreme Court ruling allowed states to opt out.
Chang said a major concern for policy makers has been that new Medicaid enrollees would be "just as sick or even sicker" than the current Medicaid population. "What we found is, that is not likely to be true," Chang said.
In her study, Chang and her colleagues used the latest nationally representative data from a federal study called the National Health and Nutrition Examination Survey, which was done between 2007 and 2010. They used the data from an estimated 13.8 million adult Medicaid beneficiaries and 13.6 million adults who are potentially eligible for such coverage under ACA.
The team compared characteristics such as age, sex, race/ethnicity, education and various health measures, measured body mass index, blood sugar levels, blood pressure, depression, tobacco and alcohol use and other information gathered from a questionnaire.
According to the study, people who gain coverage under Medicaid expansion will have an average age of 36 versus 38 for the current Medicaid population.
Some 49 percent will be male, versus 33 percent of the current population, and 60 percent will be white, compared with 50 percent now.
New enrollees also will be at least as healthy as, if not healthier than, the current Medicaid population, having fewer chronic diseases such as obesity and depression.
Alcohol and smoking are the two biggest risk factors among the new Medicaid class - nearly half are current smokers and more than a third are moderate to heavy drinkers, far more than the current Medicaid pool.
The conclusions dovetail with a study published in June by Sandra Decker of the U.S. Centers for Disease Control and Prevention which found that low-income uninsured adults who become eligible for Medicaid under the ACA are less likely to have chronic conditions such as high blood pressure, diabetes and high cholesterol.
That study, also based on NHANES data, found that when compared with those enrolled in Medicaid, uninsured adults reported better overall health, were less likely to be obese and less likely to report a physical, mental or emotional limitation. They were also much less likely to have multiple health problems.
But because this group is uninsured, people with chronic conditions such as diabetes or high cholesterol are less likely to have them under control, suggesting that once they do get coverage they are likely to need treatment.
Sara Rosenbaum, a professor in the school of public health at George Washington University in Washington, D.C., who was not involved in either study, said the findings suggest states that expand Medicaid do not have to fear they will be "burdened with the sickest, most costly, most disabled people in the state."
"There will be some of them," she said. "But most very disabled people who are poor already are on Medicaid because they are classified as disabled."
The ACA expands Medicaid coverage to otherwise ineligible individuals and families who earn up to 138 percent of the federal poverty line, or about $15,856 for a single adult and $32,500 for a family of four this year.
(Reporting by Julie Steenhuysen; Editing by Sharon Begley and Jim Loney)