Two years after Medicaid coverage was expanded under the Affordable Care Act (ACA) in their states, low-income adults in Kentucky and Arkansas received more primary and preventive care, made fewer emergency departments visits, and reported higher quality care and improved health compared with low-income adults in Texas, which did not expand Medicaid, according to a new study led by researchers at Harvard T.H. Chan School of Public Health. The findings provide new evidence for states that are debating expanding coverage to low-income adults.

The study was published August 8, 2016 in JAMA Internal Medicine.

The researchers found similar benefits for residents in Kentucky—which expanded using Medicaid managed care—and Arkansas—which used federal Medicaid funding to subsidize private insurance, the so-called “private option.”

“It doesn’t matter so much how states expand coverage,” said lead author Benjamin Sommers, assistant professor of health policy and economics at Harvard Chan School and assistant professor of medicine at Harvard Medical School. “What matters is whether they expand at all.”

So far, more than 30 states and the District of Columbia have chosen to expand coverage under the ACA. In numerous states the debate over expansion continues and in Arkansas and Kentucky, newly elected governors have proposed scaling back or overhauling their expansions.

Sommers and colleagues surveyed approximately 9,000 low-income adults in Arkansas, Kentucky, and Texas from late 2013 to the end of 2015. The results showed that, between 2013 and 2015, the uninsured rate dropped from 42 percent to 14 percent in Arkansas and from 40 percent to 9 percent in Kentucky, compared with much smaller change in Texas (39 percent to 32 percent).

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