Medicaid expansion under the Patient Protection and Affordable Care Act has the potential to shift program enrollee demographics and potentially lead to lower-than-expected spending by increasing the number of white male beneficiaries in better health than the current program population, according to an Annals of Family Medicine study.
Under the healthcare reform law, states have the option of changing their Medicaid eligibility requirements to cover people earning up to 138 percent of the poverty level. The researchers analyzed the characteristics of approximately 13.8 million current nonelderly adult Medicaid beneficiaries and 13.6 million nonelderly adults potentially eligible for Medicaid under the PPACA expansion.
According to the analysis, potentially eligible beneficiaries were 49.2 percent male, compared with 33.3 percent of current beneficiaries. The potential enrollees were also 58.8 percent white and 20 percent black, compared with the current beneficiary population distribution of 49.9 percent white and 25.2 percent black. Potential beneficiaries are also in better health, with 34.8 percent in excellent condition, compared with 33.5 percent of the current beneficiary population.
Additionally, 34.5 percent of the potential enrollees were obese, and 15.5 percent had depression, compared with 42.9 percent and 22.3 percent of current beneficiaries respectively, according to the study. However, more of the potential beneficiaries (49.2 percent) are current tobacco smokers compared with the current population (38 percent). Furthermore, 16 percent of the potential enrollees engaged in heavy alcohol use, compared with 9.8 percent of the current beneficiaries.
Overall, the researchers concluded the potential beneficiaries' generally better current health status could lead to lower-than-anticipated federal Medicaid spending in the short term. However, the higher incidence of tobacco and alcohol use means the potentially eligible population has more risk factors for chronic disease in the future.
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