Access and quality of care by insurance type for low-income adults before the affordable care act

K.H. Nguyen and B.D. Sommers

American Journal of Public Health, 2016, vol. 106, issue 8, 1409-1415

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-ofpocket 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. © 2013 American Public Health Association.

Keywords: adult; American; Arkansas; attention; health care quality; health status; human; Kentucky; lowest income group; medicaid; medically uninsured; medicare; model; public health; telephone interview; Texas; female; health care cost; health care delivery; health care policy; health insurance; insurance; male; medicaid; middle aged; poverty; socioeconomics; statistics and numerical data; United States; young adult, Adult; Female; Health Expenditures; Health Services Accessibility; Health Status; Humans; Insurance Coverage; Insurance, Health; Male; Medicaid; Medically Uninsured; Middle Aged; Patient Protection and Affordable Care Act; Poverty; Quality of Health Care; Socioeconomic Factors; United States; Young Adult (search for similar items in EconPapers)
Date: 2016
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Citations: View citations in EconPapers (4)

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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2016.303156_8

DOI: 10.2105/AJPH.2016.303156

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