Access and Quality of Care by Insurance Type for Low-Income Adults Before the Affordable Care Act

Abstract

Objectives: To compare access to care and perceived health care quality by insurance type among low-income adults in 3 southern US states, before Medicaid expansion under the Affordable Care Act.

Methods: We conducted a telephone survey in 2013 of 2765 low-income US citizens, aged 19 to 64 years, in Arkansas, Kentucky, and Texas. We compared 11 measures of access and quality of care for respondents with Medicaid, private insurance, Medicare, and no insurance with adjustment for sociodemographics and health status.

Results: Low-income adults with Medicaid, private insurance, and Medicare reported significantly better health care access and quality than uninsured individuals. Medicaid beneficiaries reported greater difficulty accessing specialists but less risk of high out-of-pocket spending than those with private insurance. For other outcomes, Medicaid and private coverage performed similarly.

Conclusions: Low-income adults with insurance report significantly greater access and quality of care than uninsured adults, regardless of whether they have private or public insurance. Access to specialty care in Medicaid may require policy attention.

Public health implications: Many states are still considering whether to expand Medicaid under the Affordable Care Act and whether to pursue alternative models for coverage expansion. Our results suggest that access to quality health care will improve under the Affordable Care Act's coverage expansions, regardless of the type of coverage.

FIGURE 1—

Association of Access to Care and Quality of Care Variables and Having Medicaid vs Private Insurance in 2013 in Arkansas, Kentucky, and Texas Note. ED = emergency department; PCP = primary care physician. The sample size was n = 2765. Adjusted odds ratios for Medicaid from multivariate logistical regression. Private insurance was the reference group for all odds ratios. Models controlled for insurance type, age, gender, marital status, education level, race/ethnicity, income, rural versus urban residence, cell phone use, political affiliation, self-reported fair or poor health, presence of chronic conditions, and state of residence.