Thursday, May 03, 2018

States that expanded Medicaid tended to improve most in latest scorecard of health system performance

States that expanded Medicaid showed the greatest improvement in health-system performance from 2013 to 2016, according to a scorecard released today by The Commonwealth Fund, which says it advocates for high-performing health systems but takes no position per se on the Patient Protection and Affordable Care Act, which enabled expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level.

A chart with the report shows the improvement and decline of each state across 37 indicators that measure access to care, quality and efficiency of care, health outcomes and income-based health care disparities. (Click on the chart to view a larger version.)

Among the nine states that improved on the most indicators, only Oklahoma has not expanded Medicaid. It did show a big drop in its smoking rate, to 19 percent from 26 percent. Commonwealth Fund President David Blumenthal said in a telephone press conference that the state's second largest city, Tulsa, "has a very aggressive, citywide health-improvement program." Researchers for the fund noted afterward that Oklahoma's improvement in the percentage of people without health insurance, to 20 percent from 25 percent, "is certainly better than nothing, but it doesn’t come close to the improvement that states like Arkansas, Kentucky or New Mexico, that did expand Medicaid, saw."

The overall rankings of health system performance placed Oklahoma next to last, behind Louisiana, where the expansion of Medicaid did not some until 2016 and thus was not reflected in the report. Hawaii, Massachusetts, Minnesota, Vermont, and Utah were ranked highest overall. In the rankings, California and Oregon rose the most, jumping nine and 10 spots, respectively.

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