Politicians call the Medicaid program that provides health care for the poor “broken.” Academic studies have reported on its limited health benefits or the longer appointment wait times that people with Medicaid face.
But as Republicans feverishly work to revise a health-care bill that would trigger deep cuts to the program over time, a massive new survey reveals that people enrolled in Medicaid rate their health care pretty high.
On a scale of 0 (“the worst health care possible”) to 10 (“the best health care possible”), more than 270,000 people covered by Medicaid in 46 states rated their health care at an average of 7.9, according to an analysis in the journal JAMA Internal Medicine. That’s just slightly worse than how Medicare enrollees rated their health care — and not far behind how privately insured patients feel about their coverage.
“The future of Medicaid is just the hottest topic in the health policy world. But it’s been, for a long time, a lot of rhetoric,” said Michael Barnett, assistant professor of health policy and management at the Harvard T. H. Chan School of Public Health. Missing from the debate, Barnett said, is what people covered by the program feel.
“If they’re satisfied, it’s really an argument: Does reducing those benefits, having fewer people on Medicaid, really improve population health?” Barnett said.
The survey took place from December 2014 to July 2015 and included a sample of people who were enrolled in Medicaid as of fall of 2013. That means it did not capture people who received coverage as a result of the Medicaid expansion of the Affordable Care Act.
The survey can’t show how the health law changed Medicaid, but it provides a snapshot across a broad swath of enrollees — including the elderly, disabled people and adults. Nearly half of the people rated their Medicaid coverage a 9 or 10, while less than 10 percent gave it a score less than 5. Older adults rated the care a bit higher than others, but their scores were strikingly consistent overall.
The vast majority of people — 84 percent — reported being able to get the care they needed over the last six months.
A common critique of Medicaid has been that the program costs the federal government a lot of money but doesn’t provide much access to health care because people struggle to get appointments or find many physicians decline to accept their coverage.
Various barriers to care have been documented, but the survey found that only 3 percent of enrollees reported not being able to get care because of waiting times or doctors not accepting their coverage.
Another issue that policymakers worry about is whether people have a “usual source of care,” meaning a primary care doctor or another kind of clinic where they can seek care in non-emergency situations.
The goal is to have people manage chronic diseases such as diabetes and prevent illness altogether, instead of waiting until they are acutely sick and must rely on the emergency room. Only 2 percent of respondents said they lacked a usual source of care because they couldn’t find a physician who took their insurance.