Debunking Medicaid Myths: Has Access Declined Under the ACA?

May 30, 2017 by Antonio Arias, MBA, CHBME

Topics: Meaningful Use Stage 2, Practice Management, Medical Billing Company

Given what a divisive policy issue it is (and has always been), myths about Medicaid have abounded for decades. Some of those myths have been incredibly damaging to the program’s perception, among patients as well as among the general public.

For example, an unproven claim that having Medicaid was “worse than having no insurance at all” – purportedly because it provides such low-quality health care – has long permeated public consciousness.

In reality, Medicaid makes a big difference in the lives of low-income individuals: A 2011 study found that compared to people without insurance, those with Medicaid had better access to and used more health care; were less likely to experience unpaid medical bills; were more likely to report being in good health; and were less likely to report feeling depressed.

In more recent years, another negative claim about Medicaid has been asserted by many in regards to the Affordable Care Act: The idea that the expansion of Medicaid coverage, state-by-state, under the ACA actually limits Medicaid patients’ access to medical care.

What reasoning lies behind such a claim? On its face, the argument makes sense in terms of economic demand and supply: Many providers over the last decade plus have greatly limited the number of Medicare and Medicaid patients they accept into their practices. Thus by expanding coverage, policy makers were (in the eyes of naysayers) giving more individuals an insurance that would only be accepted by a small number of providers – making it harder, rather than easier, for Medicaid patients to receive care.

Here again, however, the real figures prove otherwise. A study led by Daniel Polsky, PhD, professor of medicine at the Perelman School of Medicine, found that over the period from 2012 (when the ACA law was first upheld by the Supreme Court) to 2016, the ability to get a new patient appointment went up for Medicaid-covered individuals by 5.4 percentage points.

What the negative “expansion limits access” outlook failed to realize that it wasn’t just the demand for care that would change with the expansion of Medicaid across many U.S. states (including California, New Jersey, Kentucky, Arkansas, and others); so too would the supply.

According to Dr. Polsky: “With more Medicaid patients out there, physician practices must have made some adjustments to how they organize their practices to be able to give appointments to a greater fraction [of Medicaid patients].” (He also commented that the states “that have Medicaid expansion have a greater breathe of physicians who are willing and able to make appointments for Medicaid.”)

While the many policy issues surrounding Medicaid will continue to command attention over the months and years to come, access (hopefully) won’t be an area for further mythmaking. Yet as your medical practice navigates the myth-fueled waters of healthcare policy, make sure to have a trusted medical billing firm on your side to help you wade through the half-truths!


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