A recent U.S. Government Accountability Office (GAO) study of the Medicaid (called Medi-Cal in California) program found some surprising data. The GAO found Medicaid beneficiaries tend to have nearly as good access to medical care as those on private coverage, despite the public program generally offering doctors lower payments. When it came to medical care and prescription medicine, Medicaid patients reported no more challenges finding doctors than those on private coverage (not statistically significant).

However, not all segments of Medicaid patients have equal access. While children tended to have equal access to doctors regardless of their insurance source, adults on Medicaid fared worse than those on private insurance. About 7.8 percent of working-age adults with fullyear Medicaid reported difficulty obtaining care compared with 3.3 percent of similar adults with private insurance—.

The GAO report also did a bit of digging on why patients didn’t make it to the doctor. It found the biggest obstacle were not wait times or difficulty scheduling an appointment, but rather a lack of transportation. The transportation challenge was unique among those on Medicaid: It didn’t come up nearly as much with those on private insurance, or those with no coverage at all.

A McKinsey survey, released in June 2011, reported that 30% of employers whose companies offered employer-sponsored health insurance said they would “definitely” or “probably” drop coverage in the years following 2014, the year the Affordable Care Act (ACA) takes full effect. (9 percent said “definitely,” and 21 percent said “probably.”) The respondents in the survey worked for companies that ranged in size from under 20 employees to more than 10,000 employees. They represent a cross section of employer size segments, industries and geographies. All of the respondents played roles in choosing which benefits their companies provide to employees either as primary decision makers (51%) or having influence in the decision-making process.

Respondents were asked their level of awareness of nine key provisions of the ACA such as the individual mandate and employer penalties, premium subsidies and guaranteed issue. Next, the survey explored what respondents said they would do in 2014 and beyond. To make answers to those questions more informed, respondents received factual information on the major provisions of the ACA (e.g., exchange based subsidy levels by household income, guarantee issue provisions, medical underwriting and rating restrictions, and employer penalty or play-or-pay tax levels).

Respondents were then asked a set of questions on whether they thought they would maintain current coverage, offer alternative models such as defined contribution, offer mechanisms to provide employees the choice of accessing the Exchange or cease providing coverage. Respondents were also asked about their biggest concerns in ceasing coverage as well as how they would compensate employees if they did cease to provide coverage.

We were were struck by the intensity of the the negative response generated by the publishing of the McKinsey survey. In addition to the CBO, various insurance industry groups quickly came up with studies of their own predictive of a more gentle downturn in employer-sponsored coverage.

The McKinsey organization responded, “We stand by the integrity and methodology of the survey. The survey was not intended as a predictive economic analysis of the impact of the Affordable Care Act. Rather, it captured the attitudes of employers and provided an understanding of the factors that could influence decision making related to employee health benefits.”

A state evaluation gives ratings of poor to Anthem Blue Cross, Blue Shield of California, Health Net, UnitedHealthcare and Cigna in that category. Aetna performs slightly better.
Most major health insurers in California do a poor job of paying claims and providing customer service for members in preferred provider organization plans, according to a new state survey.

The evaluation by the California Department of Insurance comes as many workers assess their healthcare options this month before enrolling for another year of insurance benefits through PPO plans that serve 2.5 million people statewide.

In the quality report card, Anthem Blue Cross, Blue Shield of California, Health Net Inc., UnitedHealthcare and Cigna Corp.received the lowest possible ratings -- poor -- for customer service. Aetna Inc. earned a slightly better rating of fair.

Most of those insurers also garnered marks of fair for the ease and speed with which members see doctors and get medical care. UnitedHealthcare earned a grade of good.

No insurer received the top overall rating: excellent.

The insurers said they welcomed the scrutiny even as they defended their own efforts to improve customer satisfaction and streamline care.

But California Insurance Commissioner Steve Poizner called the findings "atrocious," saying insurers "must step up and improve the quality" of their healthcare services in a marketplace that generates $17 billion a year in revenue.

"This is hopefully a wake-up call for insurance companies," Poizner said Thursday. "They are simply underperforming. People should be concerned."

By Duke Helfand, Los Angeles Times
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