Last week Health Affairs released a new article that surveyed low-income individuals in Kentucky and Arkansas, two states that expanded Medicaid coverage to all people under 138 percent of the federal poverty level in 2014. They survey, led by Harvard professors, Robert Blendon and Ben Sommers, found that people in these states reported lower rates of problems paying medical bills and forgoing care or prescriptions due to cost. Additionally, the number of people that reported seeing a physician for a checkup and management of chronic conditions increased in Kentucky and Arkansas. All of these responses are indicators of having access to health care.
The results seen in Kentucky and Arkansas are in stark contrast to the survey results in Texas, which has elected not to expand Medicaid coverage. Texas has seen no change in an individual’s ability to pay for medical services and an increase in people forgoing health care coverage. This comparison indicates that expanded Medicaid coverage improves a person’s access to medical care.
But this isn’t the first time Medicaid has been shown to score well in measures of access to health care services for low-income individuals. Contrary to the rhetoric of politicians and the logic that Medicaid’s low reimbursement rates mean people have fewer choices of physicians, evidence to date has suggested that some of these arguments may be exaggerated.
In 2012, the Government Accountability Office (GAO) found that Medicaid beneficiaries face the same level of difficulty finding a physician that will accept their insurance as individuals with private health coverage. Similarly, the Oregon health insurance study has shown, similar to the findings in the Health Affairs study, that Medicaid coverage improves the financial stability of beneficiaries.
Last week, the president of the Indiana Hospital Association spoke at a conference on Medicaid expansion in Kansas and addressed Indiana’s experience with the expanded coverage. At one point he noted that 1,000 additional physicians are now accepting Medicaid in the state including 300 additional primary care providers since the state began offering expanded Medicaid coverage.
Part of the disconnect between the evidence and political rhetoric is that the definition of access to health care coverage is unclear. Access can be defined as being able to afford the prescriptions or services that a physician recommends, because the ability to pay for medical services can be a significant barrier to seeking care. Access can also be defined as having the ability to make appointments with a physician or health care provider to receive this medical advice in the first place.
In this case of the ability for Medicaid beneficiaries to make appointments, the supply or number of providers that are willing to see new patients indicates the level of access available to Medicaid beneficiaries. For the measure of financial stability of beneficiaries, we must largely rely on survey data to get a better understanding of medical expenses and the overall financial picture for low-income individuals. Low-income individuals face a variety of financial pressures; while relieving the pressures of medical bills may reduce a household’s financial stress, especially for families facing severe medical diagnoses, it may not necessarily be represented in surveys on financial pressures families face. Researchers should focus on surveys that ask individuals about their ability to pay medical bills as opposed to overall financial security when looking at the impact of Medicaid on access to health care, in addition to the number of providers accepting Medicaid beneficiaries.
This evidence that Medicaid expansion has been positive for individuals is not to say that Medicaid beneficiaries don’t face any issues accessing medical care. Dental coverage remains a challenge for many Medicaid beneficiaries, and the low payment rates for primary care physicians in many states make vital primary care services difficult to access . However, Medicaid coverage has been shown improve an individual’s ability to pay for medical care and some evidence has indicated that expansion of Medicaid has increased the supply of providers accepting Medicaid patients.