How Bad is Medicaid?
This is from the latest MACPAC report:
- Only 67.4 percent of primary-care physicians are accepting any new Medicaid patients, versus 85.2 percent accepting privately insured patients;
- Only 68.8 percent of parents of children on Medicaid reported that providers spend enough time with their child, versus 85.6 percent of parents of privately insured children; and
- Over three times as many children on Medicaid had two or more ER visits in the last twelve months than privately insured children (9.9 percent versus 3.2. percent).
The last two bullet points are a reflection of the recipients of Medicaid rather than Medicaid itself. It isn’t Medicaid’s fault that privately insured parents spend more time with their children over parents on Medicaid.
If recipients of Medicaid tend to be low income earners, there is correlation between low income families and an absence of parenting children.
“Over three times as many children on Medicaid had two or more ER visits in the last twelve months than privately insured children.”
Also a reflection of being in a low income or single parent family. This just reflects who benefits from Medicaid, not the program itself.
The Oregon experiment challenges that conclusion. We’re written about in on this blog. In that case, Oregonians eligible for Medicaid but waiting were entered into a lottery. Those who “won” the lottery had no different health outcomes than those who “lost”.
Also written about in this blog is the churning between Medicaid and private coverage. It is not like people are sentenced to Medicaid for their lives. So, the phenomenon cannot be a characteristic of the people, but the program.
We have a misunderstanding: “providers” refers to health-car providers, not parents.
“67.4 percent of primary-care physicians are accepting any new Medicaid patients, versus 85.2 percent accepting privately insured patients.”
Just imagine how much Medicaid expansion will limit access to health care. I suspect hat percentage getting lower.
Doctors offices just have less incentive to take people on Medicaid. It will be the same with plans on the exchanges. Access will be limited thanks to narrower networks.
Those in Medicaid normally don’t have any other options; they are covered by this program as a last resort. These numbers are great, considering that if the program didn’t exist, the time a physician spent with the children will not be shorter, it will be inexistent. Without this program instead of having to return often to the ER, many will never probably leave the ER, some would even die before having a doctor examine them. Let’s put things into perspective. Medicaid is not a perfect program, but is significantly better than the alternative. Do we need to improve these numbers? Sure, but that doesn’t mean that the program is structurally flawed.
Again, I cite the Oregon experiment, which shows that Medicaid does not cause better health outcomes than uninsured. And let’s not forget that the uninsured have access to charity care. At one time a robust voluntary, civic safety net was considered a characteristic of a civilized society, not big government.
Maybe there is no significant difference between Medicaid and the uninsured, but what about financial implications? If I am eligible for Medicaid, probably my health will be the same if I took advantage of the program or not. But if I need a treatment and Medicaid covers it my finances will not be as hurt going forward, than if I had to cover the whole costs of the procedure. Also, remember that if the individual is eligible to Medicaid a small financial hit will be significant and might destroy their chances of overcoming their situation.
Your other point of a voluntary civic safety net sounds really appealing, but I don’t know any country that has one established.
There used to be a voluntary civic safety net: That’s what our non-profit hospitals were before they became dependent on government financing!
“Those in medicaid normaly do not have other options” Welcome to the new normal! If a family of 4 applies on the health care exchange they must make 81/K a year in hawaii in 2014 to avoid having the kids automaticaly enrolled in Medicaid. So I guess you are correct they do not have other options! Medicaid.gov lays out the eligibility requirements for CHIPS and Medicaid, in states with medicaid expansion kids are enrolled in CHIPS at 300% of FPL, that is where the 81K comes from.
Medicaid.gov also has outlined the possible additional changes for the future, I can only assume these are allowed by current law. The most troubling item I have found is that in the future medicaid will allow all parents of Medicaid/CHIPS kids to enroll in Medicaid. These are people making 81k/year when the average family of 4 in Hawaii made 65k/year in 2013. That’s right everyone is going to be on Medicaid. This is the design of Obamacare. One Payer Health care here we come! No Disclosures required, by executive decree, ermm, I mean law. Sort of, anyway!
The second bullet point makes sense. Most doctors that accept patients with Medicaid practice in highly dense areas, normally areas with high concentration of Medicaid recipients. It is normal for them to see more patients a day, than other physicians. Time is a constraint, so the only way to provide care to more patients in the same time as other doctors, these physicians has to dedicate less time per patient. This is not a signal that the program is flawed; it’s just a consequence of having constraints.
Government statistics show that Medicare and Medicaid enrollees are far more likely to have emergency room visits than the uninsured or the privately insured. Granted, Medicare enrollees are in poorer health than privately insured individuals. But excess ER visits also highlight the rationing by waiting that occurs in these public programs.
Another reason for the high use of ERs by Medicaid patients is that it doesn’t cost that much (as in zero for some populations). Plus, everything is available in one place and you don’t have to miss work to go.
People on Medicaid are not necessarily irrational, they are just stuck in Medicaid.