OBJECTIVES: Prior to the implementation of the Affordable Care Act, individuals without health insurance coverage had few affordable options for complex medical care, and some turned to traveling outside of the United States for care. The objective of this study is to evaluate whether states that met the Medicaid expansion and Marketplace plan requirements at the minimal level had more individuals travel outside of the country for medical care.

METHODS: Data came from the Survey of International Air Travel (SIAT) conducted by the U.S. Department of Commerce’s Office of Travel and Tourism Industries for the years 2012 through 2015. The SIAT uses a stratified sample of inbound travelers designed to be representative of all air travelers. Outbound medical travel for US residents in 2012-2013 versus 2014-2015 were compared utilizing a difference-in-difference approach across states based on expansion of Medicaid (participated in Medicaid expansion or not) and in Marketplace type (federal Marketplace versus a state-based or state-partnership Marketplace).

RESULTS: The total number of US residents leaving the US for care increased by 15% between 2012 and 2015. The number of medical travelers increased by 19.0% in states that did not expand Medicaid coverage and decreased by 18.0% in states that expanded Medicaid coverage (p < 0.001). Medical travel decreased by 3.0% in states that participated in the federal Marketplace versus 5.9% in states that had a state-level Marketplace (p < 0.001).

CONCLUSIONS: Medical travel decreased substantially in states that participated in Medicaid expansion. The rate of medical travel is related to the ACA and may be worth considering in evaluating the program.