Common sense on Medicaid

From Health Affairs, “New Medicaid Enrollees In Oregon Report Health Care Successes And Challenges“:

Medicaid expansions will soon cover millions of new enrollees, but insurance alone may not ensure that they receive high-quality care. This study examines health care interactions and the health perceptions of an Oregon cohort three years after they gained Medicaid coverage. During in-depth qualitative interviews, 120 enrollees reported a wide range of interactions with the health care system. Forty percent of the new enrollees sought care infrequently because they were confused about coverage, faced access barriers, had bad interactions with providers, or felt that care was unnecessary. For the 60 percent who had multiple health care interactions, continuity and ease of the provider-patient relationship were critical to improved health. Some newly insured Medicaid enrollees recounted rapid improvements in health. However, most reported that gains came after months or years of working closely and systematically with a provider. Our findings suggest that improving communication with beneficiaries and increasing the availability of coordinated care across settings could reduce the barriers that new enrollees are likely to face.

There are some who hate Medicaid so much that they will actually argue that giving it to poor sick people will harm them more than it will help them. There are some who will point to the fact that since the Oregon Medicaid Study failed to show massive improvements in hypertension or diabetes, that it’s a failed program. Never mind that it was underpowered to do so. Or that we’ve never really held private insurance or Medicare to this standard.

But there are also some who think that providing access is all that matters. Give people insurance, even Medicaid, and all will be well.

Access is necessary, but not sufficient. Improvements to delivery are also needed. Those are, in many ways, harder. But they’re needed.


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