A spillover effect: Medicaid expansion leads to healthier dietary choices

Medicaid is beneficial to recipients in a multitude of ways, by reducing emergency room visits, increasing access to preventive healthcare, while reducing out-of-pocket medical costs and debt, for instance. The program is highly politicized and is met with criticism and assumptions that it is too costly, yet research has shown the program actually saves states money.

He, Lopez, and Boehm were interested in looking at other potential benefits of the program and also hoped to bridge some gaps in the literature says He,

"There are many studies about the impact of Medicaid on mental health or on health spending but few studies have looked at how Medicaid affects food choices."

He explains that by virtue of spending less on healthcare, new Medicaid recipients would have more room in their budget for food and therefore may spend more money on the same unhealthy foods and beverages they have always purchased. On the other hand, with more access to healthcare and health education through contact with providers, the researchers surmised that purchasing patterns could improve, says He.

To see if this was the case, the researchers looked at purchases of beverages such as carbonated soft drinks, juice, milk and other non-alcoholic beverages before and after the expansion of Medicaid and compared purchases in states that did and did not expand the program under the Affordable Care Act. In a way, the states that did not expand Medicaid were the control group for their study. They also compared purchase preferences for sugar content of these beverages.

"We found that households in expansion states significantly increased their purchase of diet soda and bottled water, but there was no change in purchase of regular soda. But overall, these results indicate that Medicaid expansion, in states that did expand, shifted people's purchases to products with less sugar," says He.

Access to healthcare has wide-ranging positive effects on the lives and habits of recipients. The added benefit of knowledge resulting from access to healthcare is not a policy mechanism that is usually discussed says Boehm,

"With so many people working to help people eat healthier and to reduce obesity in the US, I don't hear a lot of talk about how the provision of healthcare through this income effect we proposed in this study can help people eat and drink healthier."

Lopez says programs like Medicaid are often unfairly attacked and those attacks are done so without the numbers and data, therefore it is vital that research like this reaches decision makers.

"Besides the obvious benefit of subsidized healthcare, there is an additional spillover of the program in promoting a healthy diet by reducing one of the three evils of the American diet -- sugar -- which is bad in all respects from calories to cancer to obesity. The program contributes not just to cover the treatment of patients but also in a more preventive way," says Lopez.

The researchers add that now with the pandemic, prevention and access to healthcare is more vital than ever. This is especially true for those with pre-existing conditions and conditions that put people at an increased risk for corona virus, such as obesity.

Continued research on the implications of programs such as Medicaid are needed, says Lopez, who says policy decisions need to be made based on research, not politics.

"It's important to see if we spend this money on Medicaid, we're getting some of it back even if it's indirect," says Boehm. "Policy makers need to have this information. Not all states expanded Medicaid under the ACA, so if we have these results saying we see diet quality benefits that may help push other states to join the expansion.