- Privately insured individuals are more likely to report worse access to care, higher medical costs and lower satisfaction than those on public insurance programs like Medicare, suggesting public options may provide more cost-effective care than private ones, according to a new study published in JAMA on Tuesday.
- The study, conducted by researchers from the San Francisco Veterans Affairs Medical Center and University of California, San Francisco, comes amid a renewed push by Democrats to enact a public health insurance option, a key prong of President Joe Biden's health agenda fiercely opposed by conservatives.
- As legislators look for ways to lower costs and improve coverage, policy "efforts directed at increasing the number of individuals covered by Medicare or improving protections for individuals covered by private insurance against increasing out-of-pocket costs, high deductibles, and surprise billing may be associated with improved experience of and satisfaction with health care," researchers said.
The study's authors noted little recent research into the difference in individual experiences related to care access, cost and satisfaction between public and private health insurance across the five major forms of coverage in the U.S., though generally public programs like Medicare and military coverage are cheaper and more comprehensive.
Researchers used data from a state-based telephone survey from 2016 through 2018 of almost 150,000 people in 17 states and Washington, D.C., representing experiences of more than 61 million adults, to contrast private (individually purchased and employer-sponsored coverage) and public insurance (Medicare, Medicaid and military coverage through the Department of Veterans Affairs).
Compared to people on Medicare, individuals with employer-sponsored insurance were less likely to have a personal physician, and more likely to report instability in insurance coverage, difficulty receiving medical care or filling needed prescriptions due to cost. They were also less satisfied with their care.
Comparing people with individually purchased insurance with those on Medicare led to similar findings, researchers said.
Comparing privately insured people to Medicaid beneficiaries yielded more mixed results. People with employer-sponsored insurance were less likely to have difficulty seeing a physician because of cost or not taking medications due to cost than their counterparts on Medicaid. Results were the same when comparing people with individually purchased insurance, except there was no difference between them and people on Medicaid in reports of not taking medication due to cost.
There was no difference in coverage satisfaction between people on job-based insurance versus those on Medicaid.
However, people with private insurance — either employer sponsored or individually purchased — were more likely to report medical debt than individuals covered by any form of private insurance.
Researchers found similar patterns in comparing private insurance and military coverage.
The results suggest that generally, people with private insurance have worse experiences than those in public plans, researchers said.
However, the results could be less due to the source of coverage than the quality of benefits offered by each plan. Historically, Medicare beneficiaries have been shown to experience relatively low out-of-pocket costs and higher satisfaction.
"This suggests that our findings may be less a function of the source of coverage (in this case, a public insurer and a private insurer) than the comprehensiveness of the benefit designs," researchers wrote.
However, Democrats have zeroed in on expanding access to public coverage as a key avenue to drastically shrink the country's uninsured rate. The passage of the Affordable Care Act in 2020 led to a steady decline in the number of uninsured Americans, but that figure started to rise again in 2017 during the Trump administration. Currently, there are about 30 million uninsured people in the U.S.
During his campaign, President Biden unveiled a health plan he said would insure more than 97% of Americans, through measures like lowering the age of eligibility for Medicare to 60 and introducing a new Medicare-like public option.
Roughly two-thirds of the public have said they support a public option, as medical costs continue to skyrocket.
On Wednesday, Democrats Frank Pallone, chairman of the House Energy and Commerce Committee and Patty Murray, chair of the Senate Health, Education, Labor, and Pensions Committee, sent out a request for public feedback to help them draft legislation creating a public option, reviving a major pre-pandemic policy effort from their party.
However, hospital and health insurance lobbies fiercely oppose and will fight to quash the idea. Hospitals oppose a public option because it would lower the number of people in commercial plans, which reimburse providers at higher rates than Medicare; while payers oppose a public option because it directly threatens the massive private healthcare sector.
And it's unlikely any public option legislation would move forward in the Senate, where Democrats hold a razor-thin majority and any defectors could effectively kill the effort.