Today we are releasing our Cover Michigan Survey, 2011. Like last year’s survey, this report looks at what Michigan residents say about their access to health care. Different from last year, this survey was designed to look more in-depth at access, along with health status.
Our findings confirm last year’s major finding: Having health insurance coverage is important but not sufficient to assure access to health care.
Those who were uninsured reported that they were less connected to primary and specialty care than those who were insured, and the uninsured were much more likely than the insured to identify the emergency department as their usual source of care. This year, we also noted that those who were uninsured reported significantly poorer health status than those who were insured – 16 percent of those who were uninsured said their health status was “poor” compared to only 5 percent of those who were insured. Notably, almost one-third of the uninsured reported having been diagnosed with depression – more than twice the rate of any insured category and much higher than the national average rate of 10 percent.
But even for those who had insurance, access varied depending on the type of coverage. Last week, the New England Journal of Medicine reported on a study that showed, through a “secret shopper”-type program, that those with Medicaid coverage had a harder time getting appointments with specialists than those with other coverage—further supporting the findings in our survey.
Medicaid recipients reported a significantly harder time getting access to care than those with other coverage—and not just for specialty care. In our survey, 42 percent of those with Medicaid coverage reported having been told their primary care physician would not accept their insurance coverage, compared to only 15 percent or less for those with Medicare, employer, or individual coverage. Twenty-two percent of those with Medicaid coverage reported having been told their specialist wasn’t accepting their coverage compared to 11 percent or less for those with Medicare, employer or individual coverage. And, getting appointments with either primary care physicians or specialists was much harder for those with Medicaid than those with any other kind of health coverage. One quarter of Medicaid recipients reported that they had a very difficult time getting appointments with specialists compared to 10 percent or less for those with Medicaid, employer, or individual coverage.
The Affordable Care Act relies heavily on the Medicaid program to expand coverage to the uninsured. The findings in our survey suggest that the Medicaid program, as structured today, will be sorely challenged as several hundred thousand more people are added to its rolls in Michigan in 2014. While the federal government anticipated this challenge in part, and included a provision to pay primary care physicians at Medicare rates in 2013 and 2014, that provision will go only so far in dealing with the bigger issues in Medicaid. If we want to provide real access to care for Medicaid recipients, we’re going to need some new thinking about how to structure provider networks to care for those newly eligible—and provide better access for those currently enrolled.
Given the breadth of medical needs we found among the uninsured, all programs—public health and Medicaid alike—will have to think about ways to meet the needs of this population, with particular attention to providing better mental health care to Medicaid recipients. Today, mental health care is somewhat fragmented and significantly under-resourced. Given that one-third of the uninsured population noted that they have been diagnosed with depression—many of which will be coming into the Medicaid program—re-thinking how care is structured in this regard is paramount.
While 2014 still seems somewhat far off, the scale and significance of these changes are such that planning must begin now. And even if the Affordable Care Act were never to go into effect, our 2011 survey tells us that there are already significant access issues today for those who are on Medicaid.
We sincerely hope the data in our Cover Michigan Survey can help policy makers with the tough decisions and challenges that lie ahead.