Medicaid gets a bad rap from a lot of conservatives for poor access to health care and poor health outcomes. It’s one of the main arguments in favor of schemes to cut Medicaid funding and block grant it to the states, on the grounds it will promote efficiency and innovation in the program.

But a new study in the Journal of General Internal Medicine found that when you compare the proper groups, Medicaid actually does a better job delivering access and affordable coverage than either private coverage or Medicare.

As Aaron Carrol summed up at the Incidental Economist, the study focused on the underinsured — that is, people on insurance plans that just aren’t very good — rather than those who have no insurance. More importantly, it only looked at people at or below 125 percent of the poverty line. That’s important because the problem with the studies showing Medicaid delivering inferior results to private coverage is that it’s difficult for their comparisons to avoid the apples-to-oranges problem. Medicaid is meant for poorer Americans — you have to be below a certain income threshold to qualify for it — but private coverage is available to the poor and well-off alike. It’s a matter of basic economic logic that the private plans only the well-off can afford will will provide much better access and quality care then the plans the poor can afford as well. Products poor people can afford tend to be poor products.

That’s why safety net programs like Medicaid, which provide people more assistance than they could afford in a pure free market world, are so important. And why, when the proper apples-to-apples comparison is made between poor people on private insurance and poor people on Medicaid, the latter’s performance improves remarkably:

For the purposes of this study, underinsurance was defined as (1) having out-of-pocket expenses that were more than 5% of household income, (2) delaying or failing to get needed medical care because of cost, or (3) delaying or failing to get needed medications because of cost. This study specifically looked at adults who had full-year continuous coverage in some form, but had an income less than 125% of the poverty line. They specifically wanted to know how many of those people were still underinsured.

They found that more than a third of these adults were underinsured. What’s more is what kind of insurance left people underinsured. More than 65% of those people on Medicare were underinsured. More than 37% of people with private insurance were underinsured. But only 26% of people on Medicaid were underinsured. People who were underinsured were more likely to be White, in poor health, and unemployed. Even after adjusting for these factors, those on Medicaid were significantly less likely to be underinsured than those on private insurance (odds ratio 0.22).

The gap between Medicaid and Medicare, meanwhile, is most likely due to Medicare’s higher co-pays and other forms of cost-sharing. While this generally won’t be a problem for seniors in the middle class and up, it can be difficult for poor seniors to meet their share of the costs.

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Despite the fact that Obamacare has been in place for over three years at this point, a lot of Americans still remain confused about the specific nature of the health reform law. Last month, a Kaiser Health poll revealed that many Americans still can’t correctly identify Obamacare’s provisions. Now, Kaiser’s most recent polling finds that 42 percent of Americans aren’t sure about whether Obamacare is law at all. Seven percent of survey respondents believed the Supreme Court overturned it, and 12 percent thought Congress had repealed it:

Of course, now that Obamacare has survived a Supreme Court challenge, dozens of repeal efforts, and a presidential election, even Speaker John Boehner (R-OH) has admitted that it’s the “law of the land.” Nonetheless, as administration officials prepare for the full implementation of the law and ready the state-level insurance markets to open in 2014, they still have a long way to go when it comes to fully educating the American public about it.

Kaiser found that Americans’ education gaps fall along class lines, as wealthier Americans are more likely to have heard something about health care reform from newspapers, radio, or online sources. Just 30 percent of those with lower incomes reported that they had received information about Obamacare from those sources. That’s especially problematic because many low-income Americans stand to significantly benefit from the health law, as they will become eligible for federal assistance to help them afford insurance coverage on the state marketplaces. Still, 58 percent of uninsured Americans and 56 percent of low-income Americans told Kaiser that they don’t know how Obamacare will impact their lives.

The good news, as Wonkblog’s Sarah Kliff points out, is that there’s still some time to change the tide. Obamacare’s new health care options still won’t be available for another seven months, and some health care advocates point out that it might be confusing to tout a product that isn’t accessible yet. This summer, the nonprofit Enroll America — which hopes to increase public awareness about the impending health reform benefits — will ramp up its campaign to try to reach those four in ten Americans who still remain confused.

As Obamacare continues to take effect, and states across the country prepare to launch their health insurance marketplaces by 2014, Americans will soon be able to receive tax subsidies to help them afford their health care plans. That represents one of the health law’s most important initiatives to help ensure that everyone has access to insurance. And, according to a new study from the health care advocacy group Families USA, it’s a provision that will mainly help America’s working poor and middle class.

The Americans whose annual incomes fall between 138 percent and 400 percent of the federal poverty level — which translates to single adults earning less than $46,000 and families of four earning less than $94,000 — will be eligible for Obamacare’s subsidies. Families USA crunched the numbers to find that means about 25.7 million people will soon be able to better afford the high cost of health care. And the vast majority of those people are working Americans, who have tended to struggle to get by in the face of growing income inequality since the Great Recession:

“This reaches deeply into the middle class, as well as moderate-income families,” said Ron Pollack, founding executive director of Families USA, which released the national report. “This is a group that’s really deserving of priority help.” [...]

Most Americans, Pollack said, don’t know how the exchanges will work or that they are eligible for financial help to pay for insurance. That’s why Families USA released the report, he said.

The report shows that families that make between $47,000 and $94,000 will receive half the money, that 88% of the credits will go to working families, and that those up to the age of 36 are most likely to be eligible. Families USA did not include people who fall below 138% of the poverty line because, in the states that will expand Medicaid, they will not need subsidies.

As everyday Americans have struggled to get back on their feet after the economic downturn, the American Recovery and Reinvestment Act — colloquially known as the stimulus — went a long way toward helping lower- and middle-class families regain stability. As Families USA’s new report illustrates, the health care reform law is another federal policy that holds promise for that sector of the population as the country continues to slowly make its way toward recovery.

That’s especially true considering that the cost of health insurance plans has skyrocketed at the same time as American workers’ wages have stagnated. That means low-income Americans are increasingly delaying the health care they need because they can’t afford it. For example, poorer Americans are twice as likely as the people at higher income levels to skip out on their medication to save money. Thanks to Obamacare, many of those Americans will no longer be forced to prioritize their other bills over their health care.

But, as Pollack points out, the majority of the general public still doesn’t realize exactly how the state-level marketplaces will work or how this particular Obamacare provision will directly benefit their families. That fits into the larger national trend about Americans’ persistent misperpections about the benefits of health care reform. Health care advocates point out that there’s still a long way to go when it comes to educating Americans about what the Affordable Care Act actually does for them — thanks, in large part, to the politicized misinformation campaign that has been waged against it over the past three years.

As medical costs continue to soar, the prices for health care services have been rising across the entire industry. That’s especially true for hospital care, where an average trip to the ER costs 40 percent more than what most Americans spend on their monthly rent. Partly because doctors often don’t know the cost of the tests and procedures they’re recommending, hospitals can rack up massive profits for the services they provide — even, as it turns out, when they end up going wrong.

Even when hospitals make surgical mistakes, they still profit off of those botched surgeries, according to the results from a new study published in the Journal of the American Medical Association (JAMA). The researchers, who analyzed over 30,000 surgical procedures that took place at a 12-hospital chain in the South, found that hospitals actually profit even more off of their mistakes than they do when their surgeries go smoothly. Hospitals make about $30,000 more from the patients whose procedures result in at least one complication than they do from patients who don’t have any issues. Their profit margins tripled for privately insured people who experienced surgical complications, and doubled for Medicare patients.

“Policy makers talk about pay-for-performance, but instead Medicare and private payers are rewarding hospitals for complications,” Barry Rosenberg, one of the study’s co-authors, pointed out. “The U.S. healthcare system is paying for harm.”

How could our health care system possibly be rewarding errors so handsomely? It’s because complications resulting from surgery often necessitate follow-up care and a longer hospital stay. Of the more than more than the ones that resulted in complications forced those patients to stay in the hospital for triple the amount of time. So, when hospitals have to provide additional services resulting from one of their own mistakes, they end up being able to collect more from private insurers and the Medicare program.

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The Senate plans to begin considering the Democratic-sponsored budget resolution on Friday or Saturday, including the slew of amendments that Republican senators have tacked onto the legislation. Since budget amendments only need a simple majority to pass, GOP lawmakers have seized the opportunity to push their agenda by rushing to file hundreds of them — including several that would dismantle Obamacare.

Here are just some of the amendments that seek to undermine the implementation of the law, just as advocates prepare to celebrate its third anniversary:

REPEAL OBAMACARE: Tea Party favorite Sen. Ted Cruz (R-TX) cuts to the chase with Amendment #202, which would “establish a deficit-neutral reserve fund to provide for the repeal of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.”

PREVENT ANY NEW OBAMACARE SPENDING: Amendment #285, introduced by Sen. Robert Wicker (R-MS), wouldn’t repeal the health law outright — but it would “provide for the repeal of new spending under the Patient Protection and Affordable Care Act.”

REPEAL OBAMACARE’S FUNDING SOURCES: Several amendments seek to undermine Obamacare by preventing it from being able to use new revenue to carry out its health reform provisions. Sen. Mike Crapo (R-ID)’s Amendment #222 would “repeal the tax increases enacted under the Patient Protection and Affordable Care Act that were imposed on low- and middle-income Americans,” and Sen. Dan Coats (R-ID)’s Amendment #194 would “repeal the 3.8 percent tax on investment income imposed by the Patient Protection and Affordable Care Act.”

DELAY OBAMACARE’S IMPLEMENTATION: The health reform law’s implementation is marching forward across the country, but Sen. Richard Burr (R-NC) wants to halt that progress. His Amendment #357 seeks to “delay implementation of the President’s health care law for 2 years.”

INHIBIT MEDICAID EXPANSION: Sen. Tom Coburn (R-OK)’s Amendment #408 would “reduce the federal matching rate for Medicaid expansions,” which could threaten funding for the provision and dissuade states from opting to expand their Medicaid pools. Even though federal funding for Obamacare’s optional Medicaid expansion is not currently in question, Coburn also wants to “prevent the federal government from making an unrealistic promise to States to fund any State’s expansion of the Medicaid program at a higher level of federal reimbursement.”

ELIMINATE HEALTH INSURANCE SUBSIDIES: Two different amendments — #326 from Sen. Lindsay Graham (R-SC) and #417 from Sen. Coburn — seek to eliminate some of the subsidies that help ensure Americans can afford to purchase health care on the state-wide insurance marketplaces. Obamacare allows Americans with incomes up to 400 percent of the federal poverty level to receive some assistance to buy health insurance, but Graham and Coburn want to lower that cut-off to 300 percent.

UNDERMINE PUBLIC EDUCATION ABOUT HEALTH REFORM: Many Americans still have significant misperceptions about what’s included in Obamacare, but Sen. Pat Roberts (R-KS) doesn’t want those to be cleared up anytime soon. Roberts introduced Amendment #187 to “prohibit the use of funds for promotional or marketing materials promoting the Patient Protection and Affordable Care Act.”

Republicans have tried to repeal all or parts of the Affordable Care Act at least 54 times since its enactment.

While answering constituents’ phone calls on C-SPAN Tuesday morning, Rep. Reid Ribble (R-WI) — who is a member of the influential House Budget Committee — bucked his party’s usual line on public health care entitlements by praising the idea of allowing Americans aged 55 and older to buy into the public Medicare program for seniors.

When the Wisconsin caller asked Ribble about the reform proposal — commonly referred to as a “Medicare buy-in” — for Americans between the ages of 55 and 64, Ribble complimented the idea and asserted that the U.S. must engage in a robust and similarly innovative debate over lowering health care costs:

CALLER: Good morning. For Medicare, why can’t instead of raising the age, let people buy in at 55, at $450 a month, and then go back to $100 [a month], approximately, at 65, and you would have more money put into Medicare, and it would help the small businesses that are insuring the older people?

RIBBLE: Hey Harold, that’s a great idea. Thank you for calling from Wisconsin, I hope it’s not snowing there today. Those are the types of ideas we need to get on the table and start talking about. We recognize that the Medicare program will continue to grow based on sheer demographics of the country aging. There are fewer workers replacing those that are retiring, and so there’s gonna be pressure put on these critical programs. And ideas like yours should have a hearing and voice in the halls of Congress, and I really appreciate you coming up with suggestions like these, because these are the types of debates that have to happen. Thank you for weighing in this morning.

The $450 per month the caller suggests that individuals between 55 and 64 buying into Medicare should pay is a monthly premium that would go towards funding Medicare Part B, which is the supplemental medical insurance that covers beneficiaries’ doctors’ fees, outpatient hospital visits, and various other non-prescription drug benefits. Under the caller’s plan, that premium would eventually be reduced to the standard Medicare Part B insurance premium for Medicare beneficiaries who are 65 and over, which is about $105 per month in 2013. Medicare Part A covers inpatient hospital stays, as well as hospice services and nursing care, and does not require the vast majority of seniors to pay any premium.

While the proposal is obviously just a rough sketch, it does represent a far more progressive vision for reforming entitlements and lowering health care spending than smokescreen strategies to shift costs onto consumers such as GOP proposals to raise the Medicare eligibility age — and it could substantially lower both older Americans’ premiums and employers’ health care cost obligations to their older workers.

Ribble’s apparent endorsement of the idea comes as a surprise, as he conspicuously states on his congressional website that he voted to repeal Obamacare and obstruct several of its funding measures — although he does admit to supporting certain reform elements in the landmark health law. Nonetheless, Ribble’s comments this morning set him apart from a significant swath of the Republican Party and conservative advocates of more “free-market” approaches to health care reform that curtail, rather than expand, public insurance pools like Medicare.

Avik Roy — who advised Republican presidential candidate Mitt Romney on health care policy — and Doug Holtz-Eakin published an op-ed for Reuters earlier this week in which they outlined their vision for a “free market” approach to health care reform. It’s a serious proposal, albeit one that makes the same fallacious argument as Whole Foods CEO John Mackey’s assertion that Switzerland’s health care is more “entrepreneurial” than Obamacare is. Unfortunately, that claim is simply the least worrying aspect of a plan that is riddled with benefit cuts and shifting health care costs onto consumers.

First of all, mentioning Switzerland in the piece at all is essentially a red herring, as the duo’s proposal doesn’t actually shift American health care in the direction of the Swiss system — quite the opposite, in fact. While Switzerland shares important aspects with Obamacare, particularly its federally-subsidized health insurance marketplaces — a fact that Roy and Holtz-Eakin acknowledge, to their credit — the country’s health care program can hardly be described as a less regulated system, since it actually provides more generous insurance subsidies, requires insurers to offer at least one “nonprofit plan” akin to a public option, and imposes stricter price controls and negotiations between the government, drug makers, and health care providers.

Instead, what Roy and Holtz-Eakin want to see is a modified, and far more regressive, version of the proposal that Sen. Ron Wyden (D-OR) and former Sen. Michael Bennett (R-UT) proposed first in 2007 and then again in 2009 during the health care reform debate. Under Roy-Holtz-Eakin, Medicaid and Medicare beneficiaries would be shifted away from public insurance into private plans on Obamacare’s insurance marketplaces, consumer protections and regulations governing the marketplaces would be rolled back to encourage “innovation,” federal insurance subsidies would be limited to Americans up to 300 percent of the federal poverty level (FPL) instead of the Obamcare-mandated 400 percent FPL, and the Medicare eligibility age would be raised by three months every year indefinitely.

These are really poor ideas that would shift costs onto consumers and force many to forgo care, cut Americans’ health benefits by depriving them of Medicaid’s unique benefits, and create costlier private insurance premiums by siphoning seniors out of Medicare — all while doing absolutely nothing to lower the actual cost of American health care, which is the only real way to reduce national health expenditures.

Roy-Holtz-Eakin also caps federal insurance subsidies at 300 percent FPL rather than 400 percent FPL in an effort to contain government expenses. In the op-ed, the authors implicitly justify this by citing the example of Massachusetts — the birthplace of Obamacare — where reform has been working pretty well. But that ignores the fact that Massachusetts is a relatively wealthy state with unemployment and poverty below the national average. For the rest of the country, that cap would be pretty devastating, pricing millions of Americans out of the health care system. Roy and Holtz-Eakin also do not want subsidies to increase faster than inflation, even though that provision is meant to address the well-established reality that health care inflation tends to accelerate faster than regular inflation.

Although Roy-Holtz-Eakin may be an honest proposal for curbing costs, it is largely based on the dishonest notion that relinquishing more responsibility — a euphemism for shifting costs — onto consumers and making them pay more for their care will somehow magically curb the cost of health care. It won’t — but it will make Americans avoid receiving treatment, leading to a form of self-rationing that is particularly ironic given Roy and Holtz-Eakin’s goal of preventing government rationing of health care.

Medicare will spend $511 billion less between now and 2020 than was predicted two and a half years ago, according to the latest number crunching by the Center On Budget and Policy Priorities. More importantly, this drop occurred completely separate from any changes in government policy — rather, it resulted from an overall slowdown in the growth of health care costs.

The last time the Congress and the President actually altered Medicare policy in order to bring down the program’s spending was when they passed health reform in March of 2010. By comparing the Congressional Budget Office’s projections from August of that year with their projections from earlier this month, and by leaving out the the SGR cuts and the Medicare cuts in sequestration, the CBPP was able to isolate how much Medicare’s spending is anticipated to drop due purely to changes in the health care markets. And the drop is considerably larger than the proactive cuts in Medicare spending the Simpson-Bowles plan was calling for back in December of 2010:

According to the CBO itself, its projections for Medicare and Medicaid spending between now and 2022 dropped 3.5 percent since its previous projection in August of 2012.

Spending on Medicare and Medicaid is the main driver of the country’s long-term debt problem. But because the programs buy health care, larger economic forces in the health care market that drive up costs also drive up their spending, regardless of any specific policy enacted by lawmakers. Conversely, if health costs begin to slow, that will bring spending down — and there’s evidence that’s exactly what’s happened over the last few years.

Between 2009 and 2011, all spending in the health care system, both public and private, grew at 3.9 percent — the lowest annual rates we’ve seen in 52 years. 2012 looks like it will turn out to be similarly sluggish. Some of this is certainly due to the recession and ongoing depression. But an increasing number of economists and experts are convinced a big piece of the slowdown is also a more permanent restructuring of the way health care markets buy, sell, and deliver care.

No small part of that change may be due, in turn, to the passage of Obamacare, which put in place a host of new incentives and reforms to move health care delivery in a more efficient direction. And if Obamacare’s reforms continue pushing the health care system to adapt, then the United State’s fiscal future could continue to improve without lawmakers having to cut a dime.

This week’s issue of Time Magazine takes a deep dive into Americans’ medical bills and the roots of the U.S. health care industry’s rampant inflation — costs that force one in four American seniors into bankruptcy and over one in three Americans to forgo care.

The investigative piece highlights the exorbitant costs of the most commonplace procedures and medications, and how insurance coverage often falls through for Americans who encounter unaffordable out-of-pocket costs due to the rising price of health care technology and services. Furthermore, it is often impossible for patients to ascertain why they are being charged what they are for care — a pricing opacity that is truly unique to the service-centered health care industry. Here are the three biggest takeaways from the Time exposé on the unsustainable foundations of American health care costs — and some ideas for shifting the U.S. medical landscape towards a more equitable system: