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Has Medicaid expansion in states improved health outcomes?

Protestors call for health care beneifts

People demonstrate in support of health care in 2017 in Montana, which expanded Medicaid under the Affordable Care Act.

William Campbell-Corbis via Getty Images

This fact brief was originally published by EconoFact. Read the original here. Fact briefs are published by newsrooms in the Gigafact network, and republished by The Fulcrum. Visit Gigafact to learn more.

Has Medicaid expansion in states improved health outcomes?

Yes.

Studies have shown that Medicaid expansion in states does lead to improved health outcomes.


The Patient Protection and Affordable Care Act (ACA) sought to reduce the number of uninsured Americans through federal government subsidies of Medicaid coverage expansion. This Medicaid expansion was made optional to states, and as of May 2024 there were 10 U.S. states that had not yet implemented it. A study comparing outcomes of expansion vs. non-expansion states found a significant reduction in mortality in states that expanded Medicaid.

Individuals aged 55 to 64 with either less than a high school degree or income under the threshold (138 percent of the federal poverty level) experienced a 9.4 percent drop in mortality after expansion as compared to non-expansion states. Furthermore, research on states that already expanded Medicaid found no clear change in overall spending from state funds due to offsetting savings in health care costs.

This fact brief is responsive to conversations such as this one.

Sources

KFF Status of State Medicaid Expansion Decisions: Interactive Map

EconoFact Impact of Medicaid Expansion on State Budgets and Mortality

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Water fluoridation helps prevent tooth decay – how growing opposition threatens a 70-year-old health practice

Driving through downtown Dallas, you might see a striking banner hanging at the U-turn bridge, near the Walnut Hill exit on Central Expressway (US 75): “Stop Fluoridation!” Below it, other banners demand action and warn of supposed dangers.

It’s not the first time fluoride has been at the center of public debate.

Fluoride alternatives

For those who prefer to avoid fluoride, there are alternatives to consider. But they come with challenges.

Fluoride-free toothpaste is one option, but it is less effective at preventing cavities compared with fluoride-containing products. Calcium-based treatments, like hydroxyapatite toothpaste, are gaining popularity as a fluoride alternative, though research on their effectiveness is still limited.

Diet plays a crucial role too. Cutting back on sugary snacks and drinks can significantly reduce the risk of cavities. Incorporating foods like crunchy vegetables, cheese and yogurt into your diet can help promote oral health by stimulating saliva production and providing essential nutrients that strengthen tooth enamel.

However, these lifestyle changes require consistent effort and education – something not all people or communities have access to.

Community programs like dental sealant initiatives can also help, especially for children. Sealants are thin coatings applied to the chewing surfaces of teeth, preventing decay in high-risk areas. While effective, these programs are more resource-intensive and can’t replicate the broad, passive benefits of water fluoridation.

Ultimately, alternatives exist, but they place a greater burden on people and might not address the needs of the most vulnerable populations.

Should fluoridation be a personal choice?

The argument that water fluoridation takes away personal choice is one of the most persuasive stances against its use. Why not leave fluoride in toothpaste and mouthwash, giving people the freedom to use it or not, some argue.

This perspective is understandable, but it overlooks the broader goals of public health. Fluoridation is like adding iodine to salt or vitamin D to milk. These are measures that prevent widespread health issues in a simple, cost-effective way. Such interventions aren’t about imposing choices; they’re about providing a baseline of protection for everyone.

Without fluoridated water, low-income communities would bear the brunt of increased dental disease. Children, in particular, would suffer more cavities, leading to pain, missed school days and costly treatments. Public health policies aim to prevent these outcomes while balancing individual freedoms with collective well-being.

For those who wish to avoid fluoride, alternatives like bottled or filtered water are available. At the same time, policymakers should continue to ensure that fluoridation levels are safe and effective, addressing concerns transparently to build trust.

As debates about fluoride continue, the main question is how to best protect everyone’s oral health. While removing fluoride might appeal to those valuing personal choice, it risks undoing decades of progress against tooth decay.

Whether through fluoridation or other methods, oral health remains a public health priority. Addressing it requires thoughtful, evidence-based solutions that ensure equity, safety and community well-being.The Conversation

Noureldin is a clinical professor of cariology, prevention and restorative dentistry at Texas A&M University.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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