Debbie Nicholson

New research shows the uninsured have better overall health including less obesity.

Under the Affordable Care Act (ACA), states can extend Medicaid eligibility to nearly all adults with income no more than 138 percent of the federal poverty level, an option that could add millions of new Medicaid enrollees. "In states choosing to implement the expansion, with full federal financing from 2014 through 2016, this would expand Medicaid's traditional focus away from low-income pregnant women and children, very-low-income parents, and the severely disabled to new population groups. These include childless adults and parents whose incomes are too high to qualify for Medicaid under current state eligibility criteria. This is likely to affect the type of Medicaid patients seen by physicians in states choosing to expand Medicaid. State decisions regarding Medicaid expansion will likely consider the anticipated costs and health benefits to their populations,” according to the study’s background.

In this new study Sandra L. Decker, PhD, Center for Disease Control and Prevent, senior service fellow at the National Center for Health Statistics, and colleagues in this new study set out to document health care needs and health risks of uninsured adults who could gain Medicaid coverage under the Affordable Care Act (ACA) The information will help physicians, other clinicians, and state Medicaid programs prepare for the possible expansions.

Data from the National Health and Nutrition Examination Survey 2007-2010 were used to analyze health conditions among a nationally representative sample of 1,042 uninsured adults 19 through 64 years of age with income no more than 138 percent of the federal poverty level, compared with 471 low-income adults currently enrolled in Medicaid.

The main outcome measures were prevalence and control of diabetes, hypertension and hypercholesterolemia based on examinations and laboratory tests, measures of self-reported health status including medical conditions, and risk factors such as measured obesity status, according to the study.

The results showed that uninsured adults were less likely to be obese and sedentary and less likely to report a physical, mental, or emotional limitation in comparison to those enrolled in Medicaid. Also, the uninsured were less likely to have several chronic conditions. For example among the uninsured adults 30.1 percent had hypertension in comparison to 38.6 percent of adults enrolled in Medicare. Other examples included, hypercholesterolemia 26.8 percent uninsured adults compared to 32.0 percent enrolled in Medicaid and 33.4 percent of diabetes in the uninsured compared to 45.3 percent for those in Medicaid.

However, if they had these conditions, uninsured adults were less likely to be aware of them and less likely to have them controlled. For example, 80.1 percent of the uninsured adults with at least 1 of these 3 conditions had at least 1 uncontrolled condition, compared with 63.4 percent of adults enrolled in Medicaid.

In their conclusion the researchers write “Compared with adults currently enrolled in Medicaid, uninsured low-income adults potentially eligible to enroll in Medicaid under the ACA had a lower prevalence of many chronic conditions. A substantial proportion of currently uninsured adults with chronic conditions did not have good disease control; projections based on sample weighting suggest this may represent 3.5 million persons. These adults may need initial intensive medical care following Medicaid enrollment.”

According to the researchers this analysis had limitation including that it was not possible to definitively project the demand for health care among new Medicaid enrollees, because it is possible that their care-seeking behavior and other unmeasured characteristics may differ from those of current Medicaid enrollees.

Please note; “The findings and conclusions reported in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or the Urban Institute.”

This study appears in JAMA; The Journal of the American Medical Association.

To find out where your state stands on Medicaid expansion can be found online at


Slideshow; The "big nine" chronic conditions