The Medicaid Access Problem

The New York Times’ Denise Grady reports that children in Medicaid have a harder time accessing health care than enrollees in private health insurance:

Children with Medicaid are far more likely than those with private insurance to be turned away by medical specialists or be made to wait more than a month for an appointment, even for serious medical problems, a new study finds.

Lower payments by Medicaid, delays in paying and red tape are largely to blame, researchers say.

The study, with findings that match anecdotal reports from other parts of the country, is one of only a few efforts to measure access to health care among people with Medicaid. Nationwide, those patients are caught between states’ threats to cut Medicaid payments and the Obama administration’s plans to use the program to cover more and more people as part of its health care law.

The obvious worry is that Republicans will seize on the study to push for greater Medicaid cuts in the debt ceiling negotiations — arguing that a program that fails to provide adequate coverage deserves a place on the chopping block. But for all of Medicaid’s problems, its access challenges cannot be addressed by allowing states to push large numbers of beneficiaries off of their rolls or lowering reimbursement rates any further; that would only jepordize existing coverage.


A recent report from First Focus found that Medicaid typically offers “a broader range of services, including preventive care and special services needed by those with disabilities or other chronic conditions” at access levels that are actually “comparable to access provided under private health insurance and far better than access available to the uninsured.” In fact, “almost all children covered by Medicaid or CHIP children have a usual source of care” and “about nine out of ten publicly- and privately-insured adults had a usual source of care, compared to less than half of uninsured adults.”

Austin Frakt also points out that “Finding that some proportion of doctors doesn’t accept one type of insurance is not the same thing as finding a disparity in health outcomes caused by differences in access.” “Private plans have networks. Some are broad and some are more narrow. The study compared Medicaid to a plan with a very broad network, BCBS. By the study’s methods, individuals in plans with more narrow networks would have less access than BCBS enrollees,” he notes. That’s an important point that should caution policy makers from jumping to broad conclusions about the Medicaid program and prevent them from making any further cuts to it.