claim: “Private insurance gives … better coverage” than people would get under a Medicaid expansion.
evidence: Meanwhile, half a dozen states have received federal approval to expand under the ACA using alternative program features, including the private option.46 There is keen interest in assuring that federal flexibility does not jeopardize care for newly insured populations. We found few significant differences between Arkansas’s private option and Kentucky’s Medicaid expansion. Other than the type of coverage obtained (primarily private insurance in Arkansas and Medicaid in Kentucky), the only significant difference was higher glucose monitoring rates among patients with diabetes in Kentucky compared with those in Arkansas. All other outcomes related to utilization, quality of care, and self-reported health were similar for Kentucky and Arkansas. Of particular relevance to clinicians, we found no significant differences in access to primary and specialty care between private insurance and Medicaid expansions. Overall, more than 85% of low-income adults in both expansion states reported no difficulties obtaining physician appointments in 2015. Whether other state expansion models using different features than Arkansas’s program would produce similar results is unclear and worthy of future study. Subgroup analyses suggested that racial/ethnic minorities may be differentially affected by alternative expansion approaches. For nonwhites, the private option decreased reliance on the ED and improved self-reported health, but increased out-of-pocket spending compared with Medicaid. The latter finding likely relates to Arkansas’s decision to impose more cost-sharing for higher-income private option beneficiaries than most states require in traditional Medicaid.47 Overall, the 2 alternate expansions were associated with very similar changes for most outcomes. [...] RJ. Low-income residents in three states view Medicaid as equal to or better than private coverage, support expansion.