People remain confused about how to use the health care insurance benefits the expanded Medicaid coverage facilitated by the Patient Protection and Affordable Care Act has given them.
Studies continue to turn up evidence that the new enrollees either don't understand the benefits or don't trust what their insurance promises.
A study published in the January edition of the journal Health Affairs reported that, in Oregon, newly enrolled Medicaid patients still went to the ER for most health care treatments. These patients weren't taking advantage of health screenings, weren't setting up clinical appointments to manage chronic diseases, and essentially were treating their coverage as though it only paid for emergency medical care.
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"Medicaid expansions will soon cover millions of new enrollees, but insurance alone may not ensure that they receive high-quality care," the study's authors wrote. "During in-depth qualitative interviews, 120 enrollees reported a wide range of interactions with the health care system. Forty percent of the new enrollees sought care infrequently because they were confused about coverage, faced access barriers, had bad interactions with providers, or felt that care was unnecessary. For the 60 percent who had multiple health care interactions, continuity and ease of the provider-patient relationship were critical to improved health."
The authors said they did find health improvements in some of the new Medicaid enrollees, so all wasn't in vain.
"However, most reported that gains came after months or years of working closely and systematically with a provider.
"Our findings suggest that improving communication with beneficiaries and increasing the availability of coordinated care across settings could reduce the barriers that new enrollees are likely to face," they wrote.
The Los Angeles Times interviewed people who had just begun to receive coverage under the Medi-Cal insurance program, and found that many were intimidated by the difficulties involved in signing up for coverage. The Chicago Tribune reported that many new Medicaid patients continued to visit the ER for medical conditions that would've been covered at less cost (or might have been avoided) had they made regular appointments to visit a clinic.
"There's this idea that health insurance is like car insurance: You use it when something really bad happens," said the Health Affairs lead author Heidi Allen, a research scientist at the Center for Outcomes Research and Education, Providence Health System, in Portland, Ore. "So yearly exams and getting preventive screenings just didn't cross their minds."
Essentially, after studying new enrollees over two years, the Oregon researchers found no discernible improvement in the health of the 120 patients they followed. The use of the ER for medical matters actually increased among them.
"After two years, we weren't really able to detect any differences, even though we knew people were using more care," Allen said. "Conservatives took that as evidence that Medicaid wasn't good insurance and that it shouldn't expand."
Among the study's other findings:
- Patients assumed if they used their insurance for something minor, like a physical, someone who needed care more might not get a turn.
- The newly insured were afraid of wasting taxpayer dollars on their health care
- Patients confused dental plan limits with medical plan limits, leading to more people simply going to the emergency room and not a regular doctor's office.
- They didn't get the concept that preventive medical measures could save money in the long run
- They didn't know they should get an annual physical
- People were afraid of what a doctor's visit might cost them.
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Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
