CHA Researchers Find Medicaid Coverage Improves Access to Care


Medicaid coverage improves access to health care and chronic disease control: AJPH study

States that do not expand Medicaid miss an important opportunity to improve their population’s health, say Harvard Medical School researchers.

CAMBRIDGE, Mass. – Low-income Americans with Medicaid insurance have more awareness and better treatment of chronic diseases, such as high blood pressure, than their uninsured counterparts, a group of Harvard Medical School researchers said today. People with Medicaid are also five times more likely to see a doctor than those with no health insurance.

These are among the chief findings of a new study by a team of researchers led by Andrea Christopher, MD, a fellow at Harvard Medical School and a primary care physician at Cambridge Health Alliance, published in the American Journal of Public Health. The study is based on data gathered from 4,460 poor Americans in national surveys conducted by the Centers for Disease Control and Prevention.

The Affordable Care Act aimed to substantially expand Medicaid. With 20 red states still refusing to expand the program, many politicians argue that Medicaid coverage doesn’t improve health. A key argument is the fact that Medicaid pays doctors lower fees than private insurance and Medicare; as a result fewer providers accept Medicaid-insured patients.

“We found that Medicaid greatly improves blood pressure control,” said Dr. Christopher. “People with Medicaid were 69 percent more likely to be aware of having high blood pressure and 62 percent more likely to have control of their high blood pressure. We know that’s the key to preventing strokes and heart attacks.”

The new study’s findings conflict with some of the results of the Oregon Health Insurance Experiment, which is often cited as the main evidence that Medicaid doesn’t improve health. While the Oregon Experiment found that Medicaid improved mental health, including dramatically cutting the rates of depression, it did not improve physical health.

Christopher said, “In the Oregon study, uninsured patients averaged 5.5 doctor visits annually. That’s not the situation for uninsured patients in rural parts of the country like Idaho, where I trained. They’re lucky if they can get to see a doctor at all.”

The new study also found that nationally, 60 percent of uninsured patients had zero or one doctor visit annually. Andrew Wilper, MD, MPH, chief of medicine at the Boise VA and the study’s senior author, said: “This suggests that uninsured patients in Portland, where the Oregon Experiment was carried out, have much better access to safety-net care than do uninsured Americans elsewhere. Hence, the Oregon Experiment’s findings probably are not applicable to the nation as a whole.”

“Medicaid is clearly better than having no coverage,” said study co-author Danny McCormick, MD, MPH, an associate professor of medicine at Harvard and a physician at Cambridge Health Alliance. “The Affordable Care Act expanded Medicaid to some states, but not all. We must do better than that if we want to improve the health of all Americans.”

“Access to Care and Chronic Disease Outcomes Among Medicaid-Insured Persons Versus the Uninsured.” Andrea S. Christopher, MD, Danny McCormick, MD, MPH, Steffie Woolhandler, MD, MPH, David U. Himmelstein, MD, David H. Bor, MD, and Andrew P. Wilper, MD, MPH. American Journal of Public Health, online first, published at 4 p.m. Eastern time on Nov. 12, 2015.