Impact of the Big Beautiful Bill on Medicaid Services and Healthcare Outcomes
The Big Beautiful Bill has significantly expanded health insurance coverage for Americans, particularly through Medicaid expansion, which has improved healthcare access, financial security, and health outcomes for millions of previously uninsured individuals.
Expansion of Coverage and Access
The bill has resulted in a substantial increase in health insurance coverage, with the uninsured rate declining by 43%, from 16.0% in 2010 to 9.1% in 2015 1.
Medicaid expansion has been a major component of this coverage increase, with an estimated 13 million additional Americans gaining coverage through Medicaid 2.
For people with chronic conditions like diabetes, insurance coverage has improved dramatically across demographic groups, including men, women, non-Hispanic White people, non-Hispanic Black people, Hispanic people, and those with lower incomes and education levels 3.
Among adults with diabetes, insurance coverage increased from 85% to 95% for those with diagnosed diabetes and from 75% to 92% for those with undiagnosed diabetes 3.
For individuals with diabetes and low incomes, insurance coverage increased even more dramatically from 67% to 94% 3.
Healthcare Outcomes and Quality of Life
Research has documented improvements in access to care, with an estimated reduction of 5.5 percentage points in the share of nonelderly adults unable to afford care 1.
Financial security has improved, with an estimated reduction in debts sent to collection of $600-$1000 per person gaining Medicaid coverage 1.
Health outcomes have shown improvement, with an estimated reduction of 3.4 percentage points in the share of nonelderly adults reporting fair or poor health 1.
For people with chronic conditions like diabetes, improved insurance coverage has significant implications as both poor diabetes control and poor blood pressure control are more frequent among uninsured people than among insured people 3.
Uninsured people with diabetes are more than twice as likely to have HbA1c >9%, indicating poor glucose control 3.
Challenges and Limitations
Despite these improvements, 31 million people (9.5% of the U.S. population) remained uninsured as of 2019 3.
Geographic disparities persist, with 97% of the uninsured concentrated in the southern U.S., particularly in states that did not expand Medicaid 3.
Low-income individuals in the coverage gap are more likely to be Black, highlighting ongoing racial disparities in healthcare access 3.
Income fluctuations create instability in coverage, with more than 35% of adults with family incomes below 200% of the federal poverty level experiencing shifts in eligibility between Medicaid and insurance exchanges within six months, and 50% (28 million people) within a year 4.
The adequacy of payment rates under Medicaid remains a concern, with Medicaid rates averaging only 66% of Medicare payment rates for primary care services 3.
Financial Impact and Sustainability
The bill has begun transforming healthcare payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations 1.
These reforms have contributed to slower growth in per-enrollee healthcare spending and improvements in healthcare quality 1.
For states that expanded Medicaid, there have been gains in coverage, increased federal revenues, and improvements in healthcare access and some health outcomes 5.
However, Medicaid accounts for an estimated 27.2% of total state spending and 7.6% of total federal expenditures as of 2021, raising questions about long-term fiscal sustainability 5.
Equity Considerations
Approximately 56.4% of Medicaid beneficiaries were from racial and ethnic minority groups in 2019, making Medicaid a critical program for addressing health disparities 5.
Disparities in access, quality, and outcomes remain common among racial and ethnic minority groups within Medicaid 5.
Expanding Medicaid, addressing disparities within Medicaid, and focusing explicitly on equity in managed care and delivery system reforms represent opportunities for Medicaid to advance health equity 5.
LGBT individuals and their families face higher rates of uninsurance and economic disadvantages, making Medicaid expansion particularly important for these populations 3.
Future Directions
Additional policy reforms are needed to reduce health disparities by race and ethnicity and to help achieve equity in access, quality, and outcomes 5.
States and the federal government should adopt strategies to reduce the frequency of coverage transitions and mitigate disruptions caused by those transitions, such as establishing minimum guaranteed eligibility periods 4.
Effective payment systems for Medicaid should be grounded in the cost of care, adjusted according to disease severity, and account for nonclinical costs associated with chronic disease management 3.
The new Medicaid health home benefit provides an opportunity for states to support comprehensive care for complex conditions 3.