I teach an undergraduate health policy class at Duke University. Recently, my students asked me whether states potentially hurt themselves by offering generous health care benefits when neighboring states don’t offer such benefits. Then I got home and pulled out a recent issue of Health Affairs, and read the results of a study suggesting that this problem is, at least in the short term, pretty limited. The researchers looked at four states that had recently expanded their Medicaid programs – Arizona, Maine, Massachusetts and New York. They tested whether low income people from neighboring states moved into these generous states more often than low income people in those generous states moved out – in other words whether in-migration exceeded out-migration. Their results are pictured below:
No obvious pattern here, which to the research team suggested that there is no clear migration caused by Medicaid expansion.
This is one look at a very complex topic. And there are clearly many things other than Medicaid benefits that influence people’s migratory patterns. But for states concerned that expanding Medicaid in accordance with the Affordable Care Act will be severely punished, the study is reassuring. Expanding Medicaid does not clutter the borders with low income people who want medical care.
