The second study examined data from 2011 to 2014 and found that, in states that expanded Medicaid, patients were more likely to receive asthma treatment when it was needed, have their body mass index assessed, get pap smears and keep their blood pressure relatively stable.
"Achieving better quality in (these areas) requires medications -- access to prescription drugs," noted Amal Trivedi, an associate professor of health services, policy and practice at Brown University and an author on the second study.
Some clinic officials noted that these statistics illustrate tangible gains.
Community health centers in Michigan, which pursued the expansion, saw a double-digit increase in the percentage of Medicaid patients -- from 44 percent to 54 percent -- even as the overall number of patients served grew, noted Jen Anderson, a spokeswoman for the Michigan Primary Care Association, the trade group for the state's centers. More of those patients were diabetic or asthmatic, she added, and now able to get previously unaffordable medications.
Without that coverage, Trivedi speculated, the improvements health centers made in treating these and other conditions could be reversed.
The studies found that the centers, too, benefited from the expansion, which has allowed them to staff up to do provide mental health and other types of care.
In Pennsylvania, for instance, which has been hard hit by the opioid epidemic, more clinics have been able to develop specialized addiction treatment programs, said Cheri Rinehart, president of that state's health center association. Other clinics report that health law dollars have allowed them to hire case workers to follow up with patients to make sure they have stable housing and access to healthy food as well as transportation to doctors' appointments.
Those kinds of efforts will be much harder if Congress acts on its proposed repeal without a meaningful replacement, Gomez said.
"We'll have to cut services for everyone," she said.
At Mary's Center, she said, that would mean tamping down on dental care, cardiology or endocrinology to treat diabetes. The center would also likely downsize how many doctors and nurses it employs, making it harder to see as many patients in a timely manner.
These centers are often the only real option for care. If they can't provide a service, people will likely go without until it's an emergency, Pennsylvania's Rinehart noted.
Without the coverage expansion, community health centers "will have to re-evaluate all the services they're providing," Rinehart said. "Just like a body in crisis, you focus on the core, and lose many of the ancillary services that are critical."
(Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.)
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