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Medicaid Coverage Does Not Assure Access to Care

Summary: Coverage with Medicaid – health insurance for the poor – increased in recent years. But as a new study reveals for cancer, coverage does not guarantee access to cancer centers, due to low reimbursement rates, clunky administration, and narrow provider networks. These operational flaws are well-known and politically tolerated in Medicaid, despite the more equitable and efficient solution of high quality insurance for everyone – single payer.

Acceptance of Simulated Adult Patients with Medicaid Insurance Seeking Care in a Cancer Hospital for a New Cancer Diagnosis
JAMA Network Open
July 15, 2022
By Victoria A. Marks … Michael S. Leapman

Key Points

Question:  Can individuals insured by Medicaid access cancer care services at high-performing cancer-designated hospitals?

Findings:  In this cross-sectional study of 334 facilities recognized for cancer care, 95.5% accepted new patients with Medicaid for breast cancer, 90.4% for colorectal cancer, 86.8% for kidney cancer, and 79.6% for skin cancer (melanoma) care. Medicaid was accepted for all 4 surveyed cancers at 67.7% of facilities.

Meaning:  Despite increases in the number of US residents insured through Medicaid, these findings suggest that barriers to accessing cancer care exist at high-quality centers.

For Medicaid-Insured Patients with Cancer, Health Insurance Does Not Always Mean Health Access
Press Release
Yale School Medicine
July 15, 2022

“We found that Medicaid acceptance differed widely across cancer care facilities, with a substantial number of centers not offering services to patients with Medicaid insurance,” said Michael Leapman, MD, MHS, Associate Professor of Urology, Clinical Program Leader for the Prostate & Urologic Cancers Program at Yale Cancer Center and Smilow Cancer Hospital, and senior author on the study.

“This study underscores that having health insurance alone does not necessarily mean that patients can practically access healthcare. While major recent expansions of Medicaid have led to increases in health insurance coverage for Americans with cancer, we have to be aware and do more to ensure that insurance will actually translate to timely and high-quality care,” said Dr. Leapman.

“Despite a large increase in the number of Medicaid-insured patients, most factors that limit a hospital or physician’s participation in Medicaid have not changed,” he said. “These include low reimbursement, high administrative burden, and limited specialist participation in managed care organization networks.”

Comment by: Don McCanne

One of the successes touted by the proponents of the Affordable Care Act has been the increases in the numbers enrolled in the state Medicaid programs. Many support further expansion of Medicaid. But, as this study confirms, even for high-performing centers, access is often impaired for those covered by Medicaid, with persistence of “low reimbursement, high administrative burden, and limited specialist participation in managed care organization networks” being contributing factors.

Amongst other features, we really do need a health care financing system that is universal, comprehensive, and equitable. We are not going to find that in Medicaid – health insurance for the poor, with substandard performance. For those politicians who keep talking about expanding Medicaid, they are finally going to have to concede that the real answer is in single payer.

Besides, until then, how do the administrative personnel in these high-performing centers sort out Medicaid patients with cancer to decide which are to be sent to the door marked “Exit”?

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