qotd: Do opinions of Medicaid patients matter?

Health Affairs
October 8, 2014 (online)
Low-Income Residents In Three States View Medicaid As Equal To Or Better
Than Private Coverage, Support Expansion
By Arnold M. Epstein, Benjamin D. Sommers, Yelena Kuznetsov and Robert
J. Blendon

Abstract

Expansion of Medicaid under the Affordable Care Act to millions of
low-income adults has been controversial, yet little is known about what
these Americans themselves think about Medicaid. We conducted a
telephone survey in late 2013 of nearly 3,000 low-income adults in three
Southern states—Arkansas, Kentucky, and Texas—that have adopted
different approaches to the options for expansion. Nearly 80 percent of
our sample in all three states favored Medicaid expansion, and
approximately two-thirds of uninsured respondents said that they planned
to apply for either Medicaid or subsidized private coverage in 2014. Yet
awareness of their state's actual expansion plans was low. Most viewed
having Medicaid as better than being uninsured and at least as good as
private insurance in overall quality and affordability. While the debate
over Medicaid expansion continues, support for expansion is strong among
low-income adults, and the perceived quality of Medicaid coverage is high.

From the Discussion

In our survey of nearly 3,000 low-income adults in three states, we
found strong and consistent enthusiasm—among nearly 80 percent of
respondents—for expanding Medicaid under the ACA and a more nuanced
picture of whether it would be preferable to gain coverage via
traditional Medicaid or subsidized private insurance.

Support for expansion by the population who would most likely be
eligible for it may provide further impetus for expansion, although
low-income adults and the uninsured may lack the clout to bring about
this policy change in many states where the ACA remains unpopular among
the political leadership.

Quality and affordability of care were generally rated as better with
Medicaid coverage, while private coverage was seen as offering better
access to and more respect from providers. These views represent a
nuanced but reasonable comparison of Medicaid versus private health
insurance and are consistent with some of the empirical evidence in this
area. Recent studies indicate that Medicaid provides low-income adults
with better financial protection than does private coverage, while lower
reimbursement rates in Medicaid have been linked to lower physician
participation rates in that program compared to private coverage.
Favorable views toward Medicaid were most common among racial and ethnic
minorities, people with lower education and income, and those in worse
health.

http://content.healthaffairs.org/content/early/2014/10/02/hlthaff.2014.0747

****

The New York Times
October 9, 2014
Medicaid, Often Criticized, Is Quite Popular With Its Customers
By Margot Sanger-Katz

A study published in the journal Health Affairs found that poor
residents of Arkansas, Kentucky and Texas, when asked to compare
Medicaid with private coverage, said that Medicaid offered better
"quality of health care" and made them better able to "afford the health
care" they needed.

Medicaid, the federal-state program for poor and disabled Americans, is
a frequent political target, often described as substandard because of
its restricted list of doctors and the red tape — sometimes even worse
than no insurance at all.

But repeated surveys show that the program is quite popular among the
people who use it.

When asked to consider it alongside other big, popular government
programs, Medicaid compares favorably, said Robert Blendon, a public
health professor at Harvard who studies public opinion on health care
issues and was a co-author on the recent study. "It's only when you
compare it to Medicare, which is so much more popular than 96 percent of
what the federal government does, that it looks unimpressive," Mr.
Blendon said.

The people surveyed by the Harvard researchers didn't prefer Medicaid to
private insurance in every respect. They gave private coverage the edge
when it came to seeing "doctors you want, without having to wait too
long" and "to have doctors treat you with care and respect." But
Medicaid came out ahead on the question of whether it enabled them to
"be able to afford the health care you need," and on the overall
question of "quality of health care."

http://www.nytimes.com/2014/10/10/upshot/medicaid-often-criticized-is-quite-popular-with-its-customers.html

****


Comment by Don McCanne

Low-income patients strongly support the Medicaid program. It provides
better financial protection than does private insurance, and they
perceive the care to be of high quality. Their primary concern is that
"private coverage was seen as offering better access to and more respect
from providers" than does Medicaid.

When asked whether it was better to have Medicaid or to be uninsured,
there was strong agreement that Medicaid patients have higher quality of
care, have greater access to doctors, are treated with better respect,
and, especially, are better able to afford the health care that they
need, than are the uninsured.

In fact, according to Harvard's Robert Blendon, Medicaid compares quite
favorably to other popular government programs, though the support is
"unimpressive" when compared to the support for Medicare.

Unfortunately, the politicians in many states do not seem to care. Even
though the federal government would provide most of the funds, they
would rather leave these people uninsured. Obviously, they could care
less about the opinions of this low-income population that lacks
political clout.

Why would Medicare be more popular than Medicaid? Medicare that is
supplemented with Medigap, retiree plans, or Part C plans removes
financial barriers to care, thus providing a similar level of financial
protection as Medicaid - with the exception that Medicaid covers long
term care as well. Medicaid does have the stigma of a welfare program
whereas Medicare is considered to be an earned right available to all
qualified by age or disability. The greatest reason that Medicare is
preferred is that the patients have free choice of their physicians,
including specialists.

Under what system would a low-income patient fare best? One in which the
welfare stigma is removed, and everyone is treated equal. One in which
financial barriers such as large deductibles and coinsurance are
removed. One in which patients have free choice of their health care
professionals and hospitals. One in which a high standard of quality is
the norm for all. In other words, low-income patients would fare best is
a system that would work well for all of us - a single-payer, improved
Medicare for all.