However, a new study from the Kaiser Family Foundation reveals many low-income individuals with new coverage through marketplaces and expanded Medicaid still struggle financially and reported substantial debt, including medical debt. Many also had ongoing physical and mental health needs and were accessing health services to treat those conditions.
For the study, Kaiser Family Foundation conducted nine focus groups — three groups with Medicaid enrollees and six groups with low-income marketplace enrollees — in California, Florida, Maryland, Missouri, Ohio and Virginia. Half of these states have expanded Medicaid — California, Maryland, and Ohio.
Here are seven findings from the study:
1. Focus group participants still struggle financially, with many saying they had difficulty paying for basic expenses each month, the study found.
2. To makes ends meet, participants relied on family members and churches, in some cases, according to the Kaiser Family Foundation. Participants in the Medicaid groups were more likely to rely on other social services, but marketplace participants also sought help from food pantries.
3. Contributing to financial problems, focus group participants dealt with various chronic and acute health issues, some of which kept them from working. Kaiser Family Foundation said overall the groups reported that they were in “good” health. However, across both the Medicaid and marketplace groups, participants reported many health conditions. The most common chronic health issues across the groups were high cholesterol and blood pressure; depression, anxiety or other mental or emotional conditions; arthritis; asthma/emphysema; and diabetes. Some participants described more serious health problems like cancer, stroke, and autoimmune diseases.
4. Debt also contributed to financial problems. Nearly three quarters of focus group participants had some or a lot of debt, including debt from medical bills. Student loans and medical expenses were the biggest sources of debt. Among participants who reported medical debt, most of the medical expenses were incurred while they were uninsured, though some reported incurring medical debt while previously insured.
5. As far as enrollment, the study found Medicaid bodes well for the lowest income participants in terms of ease of enrollment, out-of-pocket costs and affordability, and ability to find providers and access care. A small number of participants reported trouble affording care that wasn’t covered (particularly for vision or dental) and difficulty finding some providers, including mental health providers.
6. In the marketplace, premiums were generally affordable, but out-of-pocket costs weighed heavily on marketplace participants, especially those with high deductible plans, the study found. Some were able to make trade-offs to purchase higher cost plans with lower deductibles to meet anticipated care needs, but not everyone was able to afford higher premiums.
7. Additionally, the fear of unknown costs was a constant worry for many marketplace participants, according to the study. Many got bills for services they thought were covered, such as screenings, colonoscopies and mammograms when issues were discovered and treated. These bills caused many to avoid getting needed care. Marketplace participants also reported trouble affording care that wasn’t covered by their plan, notably vision and some dental services.
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