What difference does Medicaid make?: assessing cost effectiveness, access, and financial protection under Medicaid for low-income adults
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (Henry J. Kaiser Family Foundation)
- Author(s):
- Coughlin, Teresa A., author Long, Sharon K., author Clemans-Cope, Lisa, author Resnick, Dean, author
- Contributor(s):
- Henry J. Kaiser Family Foundation, issuing body. Kaiser Commission on Medicaid and the Uninsured, issuing body.
- Publication:
- Menlo Park, CA : Kaiser Commission on Medicaid and the Uninsured, 2013
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Cost-Benefit Analysis Health Services Accessibility -- economics Health Services -- statistics & numerical data Insurance Coverage -- legislation & jurisprudence Insurance, Health -- economics Medicaid -- legislation & jurisprudence United States United States.
- Genre(s):
- Technical Report
- Abstract:
- As federal and state policymakers debate how to address budget deficits and states consider next steps in extending coverage to their low-income population, including implementing the ACA Medicaid expansion, information on the role that Medicaid plays in facilitating access is crucial. This analysis uses the Medical Expenditure Panel Survey to examine the use and cost of health care among low-income nonelderly adults who are covered by Medicaid relative to their expected service use and costs if they instead had employer-sponsored insurance (ESI) coverage or were uninsured. We control for a wide array of factors that also influence utilization and spending (such as individual characteristics and local factors) in an effort to isolate the specific effects of Medicaid coverage. Consistent with previous research, our analysis underscores how Medicaid coverage facilitates access to care for program beneficiaries. We find that Medicaid provides access to health care services comparable to that of ESI but at significantly lower costs. Specifically, if adult Medicaid beneficiaries were instead covered by ESI, their access to care would not be significantly different, and their likelihood of using most health care services (e.g., primary care doctors, prescription drugs and inpatient care) would not differ significantly, with the exception of emergency department use (which would go down) and specialist visits (which would go up). Moreover, despite few significant differences in the expected level of service use between Medicaid and ESI coverage, we find that adult Medicaid beneficiaries' health care costs would be over 25 percent higher if they had ESI coverage instead. Importantly, compared to ESI coverage, Medicaid affords better financial protection from medical expenses for individuals: out-of-pocket (OOP) spending for health care services would be three times higher if Medicaid beneficiaries were instead covered by ESI. For a low-income population, such an expense is a considerable financial burden that could cause individuals to delay getting needed health care. Further, our analysis confirms the better access and financial protection Medicaid beneficiaries have over their uninsured counterparts. Our projections show that, if beneficiaries did not have Medicaid coverage and were instead uninsured, they would be significantly less likely to have a usual source of care and more likely to have unmet health care need. Similarly, if Medicaid beneficiaries did not have their health insurance, projections indicate that the likelihood of their using health care services in the categories we examined would be significantly lower, except for outpatient ED use, which would be unchanged. Further, Medicaid facilitates this access to care at lower financial cost to individuals: If Medicaid beneficiaries in our sample were instead uninsured, their OOP spending would increase on average nearly four-fold. However, spending on their health care services overall would be significantly lower, as expected given the projected decrease in their service use. Even with no health insurance, these individuals would still incur health care costs, most of which would likely be uncompensated care costs that the health care system would need to absorb. Results from this study suggest that policymakers considering options to cut the Medicaid program or shift beneficiaries to private coverage should be mindful of the program's cost effectiveness and the financial benefits and access to care it provides to low-income Americans. Further, expanding Medicaid to uninsured low-income adults is likely to improve those adults' access to care and reduce the financial burden they currently face.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (15 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101611305 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101611305