While opponents of Medicaid and its expansion under the ACA continue to claim that the value and quality of care provided by Medicaid is lacking, research offers evidence that Medicaid coverage is largely comparable to private coverage (check out our factsheet for more information). According to a new study by the Commonwealth Fund, when compared to the uninsured population, Medicaid enrollees were significantly more likely to report having a regular source of care, and they were just as likely to have regular source of care as the privately insured. Perceptions on the quality of care appear to be comparable for Medicaid and privately insured individuals, with about the same proportion in each group rating the quality of their health care highly. Moreover, when compared to both the uninsured and the privately insured, Medicaid enrollees were less likely to report encountering financial issues with paying medical bills and less likely to report skipping necessary services due to the associated cost.
In addition, the Medicaid expansion made health coverage accessible to adults living in poverty. A study published by the Urban Institute in April found that the uninsured rate among poor, childless adults pre-ACA was 45.4% in expansion states, a rate that dropped by 21 percentage points to 24% between 2013 and 2015. By comparison, in 2015 the same population of adults in non-expansion states had an uninsured rate of 47.8%. Importantly, adults reporting “fair” or “poor” health in expansion states saw the largest percentage change in uninsured rates (61.7%) within the study period.
Clearly, as the Urban study implies, the choice not to expand represents missed opportunities for gains in coverage. Another report by the Robert Wood Johnson Foundation and the Urban Institute further explores the costs of the decision not to expand Medicaid by looking at the potential gains to the remaining 19 non-expansion states if they were to take up the expansion. If the 19 non-expansion states were to take up the expansion, they could see up to 5.2 million fewer uninsured people by 2021. Significantly, families in the remaining non-expansion states could see aggregate reductions of anywhere between $84.1 billion and $90.7 billion in out-of-pocket costs over a 10 year period. For previously uninsured families gaining coverage, this would represent an average decline of $574 in out-of-pocket costs. This is not surprising given previous research on the economic security that Medicaid provides to families. In sum, these studies reinforce the importance of the Medicaid expansion in improving access to health care, reducing the rate of uninsured, and providing economic security to families.