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Southern states with Medicaid expansion saw improved overall health, study shows


A new study found that Southern states with Medicaid expansion under the Affordable Care Act saw fewer declines in people’s health, resulting in an overall improvement in health for low-income adults.

The study, published by Health Affairs, examined 12 Southern states to compare those that had expanded Medicaid, like Arkansas, Kentucky, Louisiana and West Virginia, and those that have not, like Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina and Tennessee. 

The study found that declines in health status were 1.8% less likely in states that had expanded Medicaid coverage.

“We found that Medicaid expansion was associated with lower rates of self-reported health declines and a higher likelihood of maintaining baseline health status over time,” the study reads.

Of the remaining 14 states that have refused to expand eligibility for Medicaid, nine of them are located in the southern region.

The Alabama Hospital Association (AHA) estimates that an additional 340,000 people in Alabama would gain access to health coverage if the state were to adopt Medicaid expansion. A 2018 study also found that hospitals in states with Medicaid expansion are about six times, or 84%, less likely to close than states with did not adopt expansion. 

A separate study published in the Journal of the American Medical Association found that Medicaid expansion was linked to a decline in opioid overdose deaths.

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In states that expanded Medicaid, the study found a 6% percent decline particularly in deaths involving heroin and synthetic opioids other than methadone. Expansion was associated with an increase in methadone overdose mortality. 

With 82,228 opioid-related deaths from 2015 to 2017 in the 32 states that expanded Medicaid between 2014 and 2016, the study suggests that these states would have had between 83,906 and 90,360 opioid-related deaths if they had not expanded Medicaid, suggesting that Medicaid expansion may have prevented between 1678 and 8132 deaths in these states during those years. 

This decrease could be partially due to the ACA’s inclusion of mental health and Substance Use Disorder (SUD) services as essential health benefits. Expanding Medicaid eligibility increases access to these services for the low-income population.

In 2016, Alabama’s 4th Congressional District, which is made up of portions of more than a dozen counties, had the highest opioid prescribing rate at 166.69 per 100 people – more than two times the national average, according to a study from researchers at the Harvard T.H. Chan School of Public Health. Alabama’s remaining six congressional districts were ranked among the country’s top opioid prescribers.


Written By

Jessa Reid Bolling is a reporter at the Alabama Political Reporter and graduate of The University of Alabama with a B.A. in journalism and political science.



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