Five Facts about Medicaid
Medicaid now covers 73 million people, making it the nation’s largest insurer. It is the centerpiece of the U.S. health care safety net, providing benefits to adults and children who would otherwise have difficulty getting and paying for care. Yet the program is not well understood by the public.
Here are five facts about Medicaid:
1) Nearly 16 million people have gained Medicaid coverage under the Affordable Care Act’s expansions; most had previously been uninsured.
Thirty-one states and the District of Columbia have expanded eligibility for their Medicaid programs—leading to an estimated 13.3 million people gaining coverage since October 2013.1 Even in the 19 states that have yet to expand Medicaid eligibility, 2.4 million people enrolled—due to the ACA’s efforts to shed light on the program and simplify enrollment. A recent Commonwealth Fund survey found that three of five of these newly insured adults were uninsured prior to gaining Medicaid coverage. Half were either uninsured for more than two years or never had coverage (Exhibit 1).
2) Most people are satisfied with their Medicaid coverage.
A recent Commonwealth Fund survey found that 88 percent of adults are satisfied with their new Medicaid coverage: 77 percent rate it as either good, very good, or excellent (Exhibit 2). These ratings have remained consistent since 2014, when states began expanding their programs.
3) Medicaid helps people get care and improve their health.
Seventy percent of new Medicaid enrollees who’ve used health services said they would not have previously been able to access or afford their care. In 2014, adults with Medicaid coverage reported getting recommended preventive care services at rates similar to those with private coverage (Exhibit 3). Another study compared adults in two southern states that expanded Medicaid eligibility (Arkansas and Kentucky) to those in Texas, which did not. It found that people in the expansion states had greater access to primary care, were less likely to skip medications due to cost, were less likely to visit the emergency department, and were more likely to say they were in excellent health.
4) Medicaid provides access to timely care.
Findings from Commonwealth Fund surveys have found that Medicaid provides timely care to its beneficiaries. Sixty-seven percent of adults with Medicaid coverage who tried to find a new primary care doctor found it very or somewhat easy to do so (Exhibit 4) and 59 percent waited two weeks or less to see them. This is similar to wait times reported by insured adults overall.2
5) Medicaid provides comprehensive benefits and financial protection from large medical bills.
Medicaid beneficiaries in states that have expanded their programs as outlined by the ACA do not pay premiums.3 Their out-of-pocket costs, which include premiums, copayments, and coinsurance, are capped on a monthly or quarterly basis.
1 The ACA has expanded Medicaid eligibility to millions of Americans by allowing anyone who is below 138 percent of poverty ($16,243 for an individual or $33,465 for a family of four) to enroll into the program. In 2012, the U.S. Supreme Court ruled that the decision to expand Medicaid would be left up to the states. As a result, 31 states and the District of Columbia have expanded their programs, while 19 states have yet to expand.
2 In the Commonwealth Fund Biennial Health Insurance Survey, 2014: among adults who were insured all year, 56 percent of those who found a new primary care doctor got an appointment within two weeks (unpublished data). Similarly, a 2011 Commonwealth Fund survey of 19-to- 64-year-old adults found that among those insured all year who had tried to find a primary care physician in the past three years (either respondent or spouse/partner), 57 percent got an appointment within two weeks, including 35 percent who got an appointment within 1 week and 22 percent within one to two weeks. See S. R. Collins, R. Robertson, T. Garber, and M. M. Doty, The Income Divide in Health Care: How the Affordable Care Act Will Help Restore Fairness to the U.S. Health System (The Commonwealth Fund, Feb. 2012).
3 With the exception of some 1115 waiver expansion states, Medicaid beneficiaries pay nothing in premiums.