- Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
- Select an existing healthcare program or policy evaluation or choose one of interest to you.
- Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described
Healthcare Program/Policy Evaluation Analysis: Medicaid Expansion under the Affordable Care Act
Introduction
Healthcare policy evaluation plays a vital role in assessing the effectiveness, efficiency, and equity of implemented programs. It provides insight into whether a policy meets its objectives and informs necessary modifications or future initiatives. This paper analyzes the Medicaid Expansion policy under the Affordable Care Act (ACA) using a healthcare program/policy evaluation framework. It reflects on criteria commonly used in evaluations, including relevance, effectiveness, efficiency, and sustainability, while considering the implications for nursing practice and public health outcomes.
Overview of the Selected Policy
The Medicaid Expansion policy, a provision of the ACA, was implemented in 2014 to increase health insurance coverage among low-income individuals. The policy allowed states to expand Medicaid eligibility to individuals earning up to 138% of the federal poverty level. Although the Supreme Court ruled that expansion was optional for states, as of 2025, 41 states and Washington, D.C. have adopted the expansion.
Evaluation Criteria and Effectiveness
Policy evaluations of Medicaid Expansion have used various criteria to determine its effectiveness. Key indicators include:
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Access to Care: Evaluations consistently report increased access to primary care services, preventive services, and chronic disease management. States that expanded Medicaid observed significant reductions in the uninsured rate (Garfield et al., 2021).
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Health Outcomes: Improved health outcomes have been linked to Medicaid Expansion, including reductions in mortality rates, increased cancer detection, better management of diabetes and hypertension, and improved maternal health outcomes (Sommers et al., 2017).
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Cost-Effectiveness: Evaluators often analyze the financial impact of expansion. Evidence suggests that while enrollment costs increased, these were offset by reduced uncompensated care costs and increased federal funding (Blumberg et al., 2020).
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Equity and Health Disparities: Medicaid Expansion has shown to reduce racial and ethnic disparities in health insurance coverage and healthcare access, particularly among Black and Hispanic populations (Bailey et al., 2020).
Reflection on Evaluation Frameworks
Policy evaluations typically follow structured frameworks such as the Centers for Disease Control and Prevention (CDC) Evaluation Framework or the RE-AIM model (Reach, Effectiveness, Adoption, Implementation, Maintenance). The Medicaid Expansion evaluations reflect these approaches by assessing broad population reach, measurable improvements in health and financial outcomes, adoption across diverse states, and implementation challenges due to political resistance.
Implications for Advanced Nursing Practice
For advanced practice nurses (APNs), understanding healthcare policy evaluations like Medicaid Expansion is essential. It equips nurses with evidence to advocate for vulnerable populations, contribute to policy dialogues, and design interventions aligned with public health goals. Nurses play a crucial role in ensuring patients understand and benefit from expanded coverage, particularly in underserved communities.
Conclusion
The evaluation of Medicaid Expansion under the ACA illustrates how policy evaluations can assess health access, outcomes, and financial sustainability. The consistent findings of improved care access, better health outcomes, and reduced disparities demonstrate the policy’s effectiveness. As frontline healthcare providers, APNs must remain engaged in policy evaluation processes to advocate for reforms that promote equitable, efficient, and patient-centered care.
References
Bailey, S. R., O’Malley, J. P., Gold, R., Heintzman, J., Likumahuwa, S., & DeVoe, J. E. (2020). Receipt of diabetes preventive services differs by insurance status at visit. American Journal of Preventive Medicine, 58(1), 75–82.
Blumberg, L. J., Holahan, J., & Buettgens, M. (2020). The impact of the COVID-19 recession on Medicaid and ACA coverage: Updated projections. Urban Institute. https://www.urban.org
Garfield, R., Orgera, K., & Damico, A. (2021). The coverage gap: Uninsured poor adults in states that do not expand Medicaid. Kaiser Family Foundation. https://www.kff.org
Sommers, B. D., Gunja, M. Z., Finegold, K., & Musco, T. (2017). Changes in self-reported insurance coverage, access to care, and health under the ACA. JAMA, 314(4), 366–374.