The decision by United States Chief Justice John Roberts to split the Affordable Care Act baby in 2012, upholding the constitutionality of the law as a whole but letting the states decide if they would implement the Medicaid expansion part of it, has been horrible for the people in those deeply Republican states that refused to take the expansion. The only upside is that it provides a pretty much unprecedented opportunity for social scientists to determine precisely what benefits affordable health care brings to society.
It created a basic lab. Neighboring states with matching demographic profiles could be compared side by side: those that expanded Medicaid compared to what would be sort of a control group, those that didn’t. One of the findings so far is that expanding Medicaid increases voter participation. People are more invested in their government and society when they both see the benefits of it in their lives and have more time and energy and health to devote to it. A new study, reflecting the kind of stability that access to affordable health care gives people, shows that it is preventing homelessness.
This new study, from academics at the University of Colorado Boulder, Washington University in St. Louis, and the Federal Reserve Bank of St. Louis, “looks at the broader personal financial security implications of access to health insurance—beyond healthcare or even medical debt.” The authors found that those gaining health insurance both through the subsidies provided on the exchanges and through Medicaid make their rent and mortgage payments more reliably. In fact, people who got health insurance subsidized “were 25 percent less likely to miss” their housing payments.
“It’s only by virtue of the fact that some states opted out of Medicaid expansion that we’re able to assess the benefits of the ACA,” the University of Colorado’s Emily Gallagher says. “Most countries don’t change their health laws in these piecemeal ways.” It gave them the chance to study people in the coverage gap in non-expansion states, the ones who make too much for regular Medicaid and too little to qualify for subsidies to purchase individual policies on the exchange. Remember, when the law was passed, that gap wasn’t intended. It’s there because of the Supreme Court.
What’s happening for those people who have access to Medicaid coverage is that they’re not having to choose between health care and housing. They can address acute health issues and pay the rent, too. They don’t have to take as much unpaid time off of work for illnesses that go untreated, and can actually afford to live. Just like in civilized countries.