E. Richard Brown, Ph.D., Director, UCLA Center for Health Policy Research, comments on their study that demonstrated that MediCal patients report a poorer level of health than the uninsured:
"We also, of course, think the data strongly support all efforts to achieve universal coverage. An additional exhibit, number 34, shows the devastating impact of lack of coverage on people with chronic illnesses -- and the effectiveness of Medi-Cal in helping to meet their needs."
Comment: Although the report of Dr. Brown and colleagues did demonstrate that MediCal patients do report a poorer level of health than the uninsured, the importance of having this coverage cannot be understated. Unhealthy populations clearly benefit from coverage, even when the programs are under-funded (as is MediCal). Quoting from the text accompanying exhibit number 34 of their report:
"CALIFORNIANS WITH PARTICULAR HEALTH PROBLEMS"
"In addition to querying respondents about their overall health and use of services, CHIS (California Health Interview Survey) asked a battery of questions among those with particular illnesses or health problems. We report selected findings for asthma, diabetes, high blood pressure, and heart disease. The survey asked several questions (depending on the type of illness); in this section we show how the results correlate with health insurance. To simplify the presentation, we provide figures for just the three largest insurance categories: the uninsured, those with Medi-Cal or Healthy Families, and those with job-based coverage.
"Exhibit 34 shows these results for ages 18-64. The uninsured show a somewhat lower symptom prevalence of asthma than those on Medi-Cal/Healthy Families or with job-based coverage. Among those reporting asthma, however, the uninsured have similar rates of taking asthma medication as individuals with job-based coverage, but are far less likely than those with Medi-Cal. Just 41.3% of the uninsured with asthma take medications, compared to 45.1% for those with job-based coverage and 67.8% for those with Medi-Cal or Healthy Families.
"A similar trend exists among people with diabetes. Again, prevalence rates are lower for the uninsured, but among those who report having diabetes, far fewer are taking insulin or pills: 57.8% of the uninsured compared to 75.4% and 75.7% of those with Medi-Cal/Healthy Families and those with job-based coverage, respectively.
"Among people with high blood pressure, again the pattern is the same. Fewer uninsured report having high blood pressure, but there is a dramatic difference by insurance status in whether they take medication for this problem. Only 29.5% of the uninsured with high blood pressure take medications, about half that for those with Medi-Cal/Healthy Families (61.3%) or job-based coverage (53.1%).
"Finally, the data on heart disease exhibits the exact same pattern. Although fewer uninsured report having heart disease, those with this condition are much less likely to take medications. Just 27.2% of the uninsured indicate that they take medication for it, compared to 60.1% of those with Medi-Cal/Healthy Families and 42.4% of those with job-based coverage.
"Overall, then, we see that insurance coverage is strongly correlated with taking medication for chronic diseases. In addition, it is noteworthy that for three of the four chronic diseases (asthma, high blood pressure, and heart disease), far more individuals with Medi-Cal take medication than those with private coverage. This indicates how important Medi-Cal coverage can be for improving health behaviors. Although it is not possible to prove that uninsurance causes Californians to refrain from taking needed medications without controlling for confounding variables, such a sequence of events is highly likely given the high price of medicines and the relatively low incomes of uninsured individuals and families. Combined with our findings from the previous subsection that showed lower health status, utilization, and lack of regular sources of care, it is clear that the uninsured face numerous obstacles in attempting to use California's health care system."
Further comment: An important feature of MediCal, from the patient's perspective, is that it provides comprehensive benefits with virtually no out-of-pocket expenses. From the perspective of the health system, the under-funding creates problems for everyone because of significant cost shifting, and it threatens the financial solvency of MediCal providers. So access is improved by the elimination of individual financial barriers to care, but it is impaired by the failure provide enough funding to assure broad participation by the providers of care, though this study indicates that the former plays a much, much greater role. Since MediCal does play a very crucial role in providing access to care it must be vigorously supported until a universal system is in place. But, also, we can't let up on our efforts to attempt to replace this flawed system with an equitable, comprehensive program of health care coverage for everyone.