Medicaid Coverage as Good as Private Insurance, Survey Shows

Ken Terry

April 27, 2017

Medicaid coverage is not only substantially better than being uninsured, but it is also as good as or better than private insurance in providing access to care, according to a new survey of 6000 people by the Commonwealth Fund, a New York–based think tank.

The report finds that the large majority of people who have continuous Medicaid coverage are able to get the care they need. On the basis of the survey results, 91% of them have a regular source of care, compared to 93% of privately insured people with continuous coverage, and 77% of people who were uninsured for at least part of the year.

Fifty-seven percent of Medicaid enrollees rated their care as very good or excellent, vs 52% of the privately insured and 40% of the uninsured.

Medicaid enrollees were much more likely than the uninsured to receive preventive care, such as blood pressure checks, cholesterol screenings, and flu shots, the survey shows. They were also more likely to receive cancer screenings, such as mammograms and colonoscopies.

The survey's findings arrive amid the controversy over the Republican's American Health Care Act (AHCA), which would end the expansion of Medicaid begun under the Obama administration and would cap federal Medicaid spending. The AHCA — a would-be replacement for parts of the Affordable Care Act (ACA) ― has not reached the floor of the House of Representatives because it lacks sufficient support among Republicans. Nevertheless, negotiations on the legislation have continued, and President Trump has demanded a vote on a revised version of the bill.

The authors of the Commonwealth Fund report that some policy makers contend that Medicaid — which covers more than 70 million people — provides much poorer access to care than private insurance or is hardly better than no insurance.

"Significant Cost Protection"

"This research — and a substantial body of research on the effects of Medicaid coverage — doesn't support that claim," said Sara Collins, PhD, vice president for healthcare coverage and access at the Commonwealth Fund, in an interview with Medscape Medical News.

Some observers argue that Medicaid enrollees have less access to care than the privately insured because Medicaid payment rates tend to be lower than those of private health plans. Dr Collins doesn't deny that Medicaid rates are lower. That's one of the reasons why primary care physicians received a temporary bump in Medicaid payments under the ACA, she noted. But the expiration of that raise in 2015 apparently did not lead to an exodus of primary care physicians from Medicaid, she observed.

"Had this [expiration of the higher rates] reduced healthcare access for Medicaid enrollees, we would have expected to see evidence of that in the survey, and we just don't see it," she said. "People are receiving preventive care services in Medicaid at similar rates as people in private coverage."

According to the survey, Medicaid patients got same-day appointments at a somewhat lower rate than people with private coverage and at a higher rate than uninsured patients did. But there were no significant differences among the three groups in wait times for specialist appointments.

Another Commonwealth Fund study, Dr Collins said, found there were consistent wait times for both primary care and specialty appointments among enrollees in ACA exchange plans, as well as Medicaid enrollees and people with employer-based insurance. Although wait times were longer in underserved rural and urban areas than in other areas, those wait times were consistent across insurance types, she said.

The new research also shows that cost-related problems with access to care are significantly lower among Medicaid enrollees than among the uninsured or people with private insurance. For example, 17% of privately insured adults, but only 7% of Medicaid enrollees, reported skipping a recommended medical treatment, test, or follow-up visit because of the cost. And 35% of those with private coverage reported having problems paying medical bills, vs 12% of Medicaid enrollees.

The study authors suggest that the difference between the financial protection of Medicaid and that of private insurance is "a possible reflection of steady increases in private plan deductibles and copayments in recent years."

By contrast, Dr Collins noted, "Medicaid has historically provided significant cost protection for enrollees. It has very comprehensive benefits and no premiums in most states."

Another Commonwealth Fund study, she added, showed that Medicaid patients have lower out-of-pocket costs than do people of equivalent income who enrolled in ACA marketplace plans in states that have not expanded their Medicaid programs. This is despite the fact that the latter group of people, who have incomes from 100% to 138% of the poverty level, received heavy government subsidies for premiums, copayments, and deductibles.

"Medicaid Improves Access"

Health insurers, many of which offer Medicaid managed care plans, are strong supporters of Medicaid. Cathryn Donaldson, a spokeswoman for American's Health Insurance Plans (AHIP), the trade association for the industry, told Medscape Medical News, "AHIP has long supported the Medicaid program because it works ― it works for beneficiaries and it works for states.

"The key take-away for us from this [Commonwealth Fund] study is that Medicaid improves access to services ― importantly, preventive services ― and reduces costs overall. Through the Medicaid program, beneficiaries are getting healthier, they're finding doctors, they're contributing to the economy, and the program itself is a breeding ground for innovative health solutions."

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