Access To Care: How Much Difference Does Medicaid Make?

Abstract

PROLOGUE: The recent passage of the State Children's Health Insurance Program (CHIP) prompted a number of states to pass new laws aimed at reducing the number of uninsured children. Still, many states persist in playing political football with the issue of children's health insurance. For example, in April of this year, the Virginia General Assembly passed a bill that would provide insurance to 83,000 uninsured children of low-income, working Virginians. However, the bill was passed only after a rancorous debate on the issue that included a veto by Governor James Gilmore, who had opposed expansions to the state's Medicaid program. Whatever the governor's ideological misgivings concerning Medicaid, recent evidence, such as that presented in this paper by Marc Berk and Claudia Schur, suggests that that oft maligned program serves not only as a necessary bulwark against high-cost medicine, but also as a gateway to regular and timely access to routine and preventive care. Few have been more active than these authors in the debates surrounding Medicaid and access to care. Since the early 1980s their work on these issues has appeared regularly in a number of health policy and research journals. Berk is director of the Project HOPE Center for Health Affairs (CHA), where he has been since 1988. He holds a doctorate in sociology from New York University. Schur, who earned a doctorate in economics from the University of Maryland, is deputy director of CHA. Prior to joining CHA, both authors were with the National Center for Health Services Research (now the Agency for Health Care Policy and Research): Berk as a senior sociologist, Schur as an economist. Both played integral roles in the design and implementation of the 1987 National Medical Expenditure Survey. ABSTRACT: Using the 1994 Robert Wood Johnson Foundation National Access to Care Survey, we examine the likelihood of having a usual source of care, inability to obtain needed care, and number of physician visits for persons with private insurance, Medicaid coverage, and no insurance. Inability to obtain services is surprisingly consistent: For each service, Medicaid enrollees were about half as likely as uninsured persons and about twice as likely as privately insured persons were to report difficulty. For other access measures, access for those on Medicaid more closely resembles that of the privately insured than that of the uninsured.

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