Looking at the Impact of a Public Health Care Expansion

Assessing the impact on health system capacity and cost-of-coverage expansion under health reform

Dates of Project: July 2012 through December 2013

Description: Researchers from the University of Wisconsin-Madison compared health care use of low-income childless adults in rural Wisconsin before and after enrollment in a state public health insurance program, the BadgerCare Plus Core Plan.

Using data from the state’s Medicaid program and a large rural health system, they examined health care utilization (emergency room visits, inpatient hospital stays, and outpatient appointments) by childless low-income rural residents before and after the launch of the Core Plan covering low-income childless adults.

Separately, they compared the use of mental health and substance use services by low-income childless adults in Milwaukee before and after the Core Plan program launch.

Key Findings

  • People who enrolled in the BadgerCare Plus Core Plan coverage showed a substantial increase in visits for preventive and inpatient care relative to a comparison group of non-enrolled people.

  • Core Plan enrollees showed no statistically significant change in emergency department use or behavioral health visits. This latter finding is likely explained by the Core Plan’s limited coverage for behavioral health services.

  • In the Milwaukee study, the number of outpatient visits and emergency department admissions increased after the Core Plan took effect, but there was no significant change in inpatient admissions.

Citations
Burns ME, Dague L, DeLeire T, Dorsch M, Friedsam D, Leininger LJ, Palmucci G, Schnelzer J, and Voskuil K. “The Effects of Expanding Public Insurance to Rural Low-Income Childless Adults.” Health Services Research, September 2014. DOI: 10.1111/1475-6773.12233. Abstract available online.

DeLeire T, Dague L, Leininger L, Voskuil K and Friedsam D. “Wisconsin Experience Indicates That Expanding Public Insurance To Low-Income Childless Adults Has Health Care Impacts. Health Affairs, 32(6): 1037-1045, Jun2 2013. doi: 10.1377/hlthaff.2012.1026.