A new study strongly rejects the common GOP talking point that Medicaid enrollees are unhappy with their health care coverage, and that they would be better off buying private insurance or going without insurance altogether.
Released on Monday by the Journal of the American Medical Association (JAMA), the survey is the largest to date showing that Medicaid enrollees are happy with their coverage under the Affordable Care Act (ACA, or Obamacare). Numerous studies have shown that Medicaid increases people’s access to care, but the new survey hones in on their satisfaction with that care — something that users report in high numbers.
Overall, Medicaid enrollees across a range of demographics rated their health care 7.9 on a 0 to 10 scale, with 46 percent giving their coverage a score of 9 or 10. Only 7.6 percent gave a score under 5.
“In summary, we found that Medicaid enrollees are largely satisfied with their care, and that few perceive their insurance as a major barrier to care,” write the study’s authors. “Changes to Medicaid that would result in millions of beneficiaries losing coverage could have major adverse effects.”
The study comes as the Senate debates the latest version of President Donald Trump’s health care bill, which would leave an estimated 22 million more Americans without health insurance, in no small part because of the legislation’s devastating cuts to Medicaid.
Medicaid covers 20 percent of all Americans, 60 percent of all children with disabilities, and 64 percent of all nursing home residents, as well as 49 percent of all births. A partnership ensuring that vulnerable Americans (many of whom are low-income, elderly, and/or disabled) receive health insurance, the cost of Medicaid plans is covered in part by the government (64 percent on average) and in part by states, which make up the difference. But under the Senate bill, this approach is replaced with caps on how much money individual states receive per year. Over time, the cap will lose value — effectively doing away with Medicaid.
While some conservatives have argued the cuts don’t exist, others have acknowledged that the bill is attempting to do away with Medicaid, but have justified them by claiming that Medicaid coverage is no different than being uninsured. Right-wing health care analyst Avik Roy advanced this argument in the Washington Post last month.
“The Senate bill repeals Obamacare’s Medicaid expansion — an expansion that has trapped more than 12 million people in a program that researchers have shown has health outcomes no better than being uninsured,” Roy wrote, citing a single study from Oregon. “In its stead, the Senate bill offers low-income Americans robust tax credits to buy affordable private health insurance, just as those formerly enrolled in Obamacare’s exchanges will be able to.”
But JAMA’s broader survey refutes that line of thinking. Just 3 percent of enrollees reported not being able to get care, either because of waiting times or because their insurance was not accepted by physicians—a far cry from equating Medicaid with a lack of insurance.
That reality is something that some Republicans grasp. “If Medicaid expansion goes away and if there is no coverage, that’s a bad thing,” Senator Bill Cassidy (R-LA) said in June. But he offered a swift caveat. “On the other hand, if they move from Medicaid to private insurance, that could be a good thing.”
Moving to private insurance is unlikely, health experts say — low-income Medicaid enrollees often can’t afford that and are more likely to just forego coverage altogether. For many, the outlook is grim without affordable coverage. The New England Journal of Medicine has noted that Medicaid expansion has saved one life for every 239 to 319 people covered, meaning the Senate’s bill would put thousands of enrollees at risk.
But some Americans do stand to benefit from the GOP’s so-called Trumpcare bill. The top 400 highest-income households will see major tax cuts under the legislation, according to the Center on Budget and Policy Priorities (CBPP), a progressive think tank. The CBPP also found that households with incomes above $1 million a year would receive annual tax cuts averaging greater than $50,000 each, more than the cost of continuing Medicaid expansion for eight people.