January 05, 2021
According to researchers of a recent JAMA Network Open study, when comparing utilization, cost, and quality of public (Medicaid) and private health insurance (Marketplace), data showed that there are more important differences than previously thought.
Using a multivariate regression analysis, Heidi Allen, PhD, MSW, Columbia University School of Social Work, New York, NY, and colleagues, conducted a cross-sectional study of 8182 low-income nonpregnant adults aged 19 to 64 years enrolled in Medicaid or Marketplace coverage during the 2014 to 2015 period, with incomes between 134% and 143% of the federal poverty level (FPL). Data was obtained from 3 state agencies merging comprehensive insurance claims with income eligibility data for Colorado Medicaid expansion and Marketplace enrollees.
Primary outcomes measured were months of coverage either public/private, office and ED visits, ambulatory care–sensitive hospitalizations, and total costs. Secondary outcomes included prescription drug utilization, types of ED visits, hospitalizations, out-of-pocket costs, and clinical quality measures.
According to the findings, “Public coverage through Medicaid was associated with more ED visits and fewer office visits than private Marketplace coverage, which may reflect barriers to outpatient care or lower cost-sharing barriers to ED care in Medicaid.”
Some potential explanations for this trend could be that Medicaid enrollees have limited access to outpatient care, so patients turn to the ED. Another possibility the researchers point to is Medicaid’s policy of retroactive eligibility, which creates a new path to gain coverage, one the Marketplace does not offer.
The researchers explained that these results “suggest that Medicaid coverage is substantially less costly to beneficiaries and society than private coverage, with mixed results on health care quality.”
In terms of costs, spending for Marketplace-eligible adults was 80% higher than those enrolled in Medicaid, but when claims were adjusted to Medicaid pricing, the cost differences were no longer significant. However, out-of-pocket costs for low-income enrollees was 10 times higher for the Marketplace compared with Medicaid.
No significant difference was discovered for clinical quality for the primary outcome of ambulatory care-sensitive hospitilizations.
“With policy makers considering a range of policies to expand coverage, understanding the trade-offs between these coverage types is critical,” concluded the researchers.
Allen H, Gordon SH, Lee D, Bhanja A, Sommers BD. Comparison of utilization, costs, and quality of Medicaid vs subsidized private health insurance for low-income adults. JAMA Netw Open. 2021;4(1):e2032669. doi:10.1001/jamanetworkopen.2020.32669