Medicaid enrollees like their coverage — and are scared Republicans will take it away

There is a persistent myth in American politics that Medicaid is broken — but Medicaid enrollees don’t see it that way at all.

Medicaid patients rated their health coverage just as highly as people who get insurance at work, a new Vox/SurveyMonkey poll finds. They are also the group most fearful of how the Republican health care plan would affect their lives.

Our poll finds that 79 percent of Medicaid enrollees say they are “very or somewhat satisfied” with their health coverage, compared with 81 percent of people who get coverage at work.

The people who are least satisfied with their coverage are people who buy their own health coverage, including those who use the Obamacare marketplaces.

Medicaid enrollees both like their coverage and are afraid to lose it. When you sort people by what type of health insurance they have, it is Medicaid enrollees who most expect to be worse off under the Republican health care bill.

Only 12 percent of Medicaid patients expect to be better off under the American Health Care Act — while 49 percent expect their lives will be worse. An additional 36 percent expected their coverage to stay the same.

No other group of Americans expressed such negative expectations for the Republican plan.

Medicaid covers an estimated 70 million Americans, and often gets a bad rap in Washington because it is accepted by fewer health care providers. Patients often face longer wait times than those with private insurance, especially for specialists.

A Centers for Disease Control and Prevention study in 2013 found that 68.9 percent of physicians were accepting new Medicaid patients, compared with 84.7 percent accepting new patients with private coverage.

This discrepancy, however, seems to be most prevalent in urban areas. In rural areas, where doctors may have fewer patients to choose between, the CDC actually finds no difference between doctors accepting Medicaid and those accepting private coverage.

The research suggesting that Medicaid patients wait longer to see doctors is robust too.

But what these studies often miss is how Medicaid enrollees feel about their coverage. One thing I’ve found in my interviews, which is reflected in this new data, is that Medicaid enrollees think their coverage is very good.

Clifford Hoskins, a 62-year-old retired coal miner I met in Kentucky last month, described Medicaid as “the best insurance I ever had in my life.” Medicaid covered a recent ankle replacement surgery.

Brandon Bolton, a 19-year-old dishwasher who also lives in Kentucky, raved about the benefits.

“This is actually good insurance,” he said when we met last December. “I was able to go see any doctor I wanted, didn’t have to pay nothing. No medicine fees, no copays, nothing.”

Bolton was speaking in the past tense because he was at an appointment to re-enroll in the program; he had missed some paperwork sent in the mail that led to him losing coverage. But he liked the plan — it helped pay for medications to treat his bipolar disorder and ADHD — and wanted to get back onto it.

“I was going to the doctor once a month,” he said about the time he had Medicaid. “I was diagnosed with ADHD, OCD, and bipolar, so I’m always kind of on edge. I was seeing her, and she was somebody I could talk to on a monthly basis.”

Some marketplace enrollees I’ve interviewed have even expressed envy of the Medicaid program, how easy it is for people who qualify for the public program to go to the doctor without racking up big medical bills.

“They can go to the emergency room for a headache,” one Obamacare enrollee, who did not want her name used, has told me. “They’re going to the doctor for pills, and that’s what they’re on.”

In many ways, it seems clear why Medicaid gets such high marks. Enrollees don’t pay a premium and are charged little to no copayment when they do use the doctor. The fees for filling a drug prescription are minimal. These benefits of the public program seem to outweigh any challenges faced getting appointments or waiting in doctors’ offices. The public policy debate often overweights that data without talking to actual Medicaid enrollees about how the coverage works for them.

More than any other group, Medicaid enrollees say they believe the Republican health care plan would leave them worse off. Forty-nine percent expect they’ll be left worse off under the AHCA, compared with 41 percent of people who buy coverage at work and 42 percent who buy their own plans.

Medicaid enrollees have good reason to worry: The House-passed American Health Care Act would phase out the Medicaid expansion beginning in 2019. It would also change how the federal government reimburses states for Medicaid expenses, and would introduce the option of states turning the money into a “block grant,” a lump sum rather than a per-person payment for each Medicaid patient, which would cut the program still further.

The Congressional Budget Office estimates that these changes would cut $880 billion from the Medicaid program and cause it to cover 14 million fewer people by 2026.

This includes all those people who like their Medicaid coverage — who say they’re satisfied with those plans. This includes people like Hoskins, the retired coal miner.

“If they do away with this, there are going to be a lot of changes to my voting,” says Hoskins, who is a registered Republican. “This is my biggest issue right now.”