Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Journal Article


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

people health insurance


States considering expanding their Medicaid programs have the option of purchasing private insurance for low-income adults rather than enrolling them in the public program. Several states are moving ahead with this option, and others are considering it. However, it’s unclear whether people would be better off with private insurance. Commonwealth Fund–supported researchers surveyed residents in Arkansas, Kentucky, and Texas to determine how their perceptions of access and quality differed according to their insurance status and type.

What the Study Found

The survey was completed in 2013 before the Affordable Care Act’s coverage expansions took effect. It included respondents with private insurance, Medicaid or Medicare coverage, or none at all. For most measures of access to outpatient care, adults enrolled in Medicaid fared similarly to their insured peers with the exception of specialty care.

Medicaid offered better financial protection to low-income adults than private insurance. Those with Medicaid were significantly less likely to have spent more than $1,000 in out-of-pocket costs for medical care in the past year than those with private insurance. Low-income adults perceived private coverage and Medicaid as similar in overall quality.

Uninsured respondents, however, consistently reported worse outcomes, were at significantly higher risk of not having a personal doctor, and reported difficulty accessing primary and specialty care. They were significantly more likely to report delaying care because of cost than those covered by Medicaid and private insurance, and to use the emergency department as a usual source of care.


Coverage expansions for low-income adults will likely lead to gains in overall access, regardless of whether people have public or private insurance.

Publication Details



Kevin Nguyen


K. Nguyen and B. Sommers, “Access and Quality of Care by Insurance Type for Low-Income Adults Before the Affordable Care Act,” American Journal of Public Health, published online May 19, 2016.