emergency medicine

Expanding Medicaid may be costly to states

PENN STATE (US) — Extending Medicaid coverage to currently uninsured adults is likely to increase the cost of the program, say researchers, because those patients are prone to having more expensive health problems.

The Affordable Care Act gives individual states the option to expand their Medicaid programs to cover many who are uninsured.

“We sought to compare the health needs and health-services utilization of the uninsured who are served by safety-net providers with those of nondisabled adult Medicaid recipients living in the same county, in order to help project the potential financial impact of enrolling uninsured people in Medicaid,” the researchers write in a new study published in the North Carolina Medical Journal.

Wenke Hwang, associate professor of public health sciences at Penn State College of Medicine, and colleagues studied these two groups in Buncombe County, North Carolina, in 2008. Buncombe County’s clinics and safety-net providers maintain comprehensive records about patients and the treatments they receive, offering the opportunity to assess the general health status and needs of the uninsured population.


Uninsured patients are less likely to be admitted to a hospital or to visit an emergency room or outpatient clinic than Medicaid recipients. However, the uninsured tend to have ailments that cost more to treat than those with Medicaid.

“We found that if the low-income uninsured non-elderly adults had been covered by Medicaid, based on their illness burden profiles, they would have incurred 13 percent more costs on average than the non-elderly Medicaid recipients,” says Hwang.

“This means that the non-elderly uninsured population has, on average, a slightly higher disease burden than the non-elderly Medicaid recipients.”

The new study looked at nearly 11,000 people over the course of the year. Medicaid recipients accounted for 7,191 of them and uninsured county-clinic patients numbered 3,603.

“Health reform laws will provide insurance coverage to many currently uninsured populations,” says Hwang. “However, it may be more cost effective to simply strengthen the financial viability of the current safety-net providers without expansion of state Medicaid.”

Researchers from Wake Forest University contributed to the study, which was supported by the Robert Wood Johnson Foundation.

Source: Penn State

Related Articles