title: Access and Quality of Care by Insurance Type for Low-Income Adults Before the Affordable Care Act.
abstract: To compare access to care and perceived health care quality by insurance type among low-income adults in 3 southern US states, before Medicaid expansion under the Affordable Care Act.
  
  
  
  We conducted a telephone survey in 2013 of 2765 low-income US citizens, aged 19 to 64 years, in Arkansas, Kentucky, and Texas. We compared 11 measures of access and quality of care for respondents with Medicaid, private insurance, Medicare, and no insurance with adjustment for sociodemographics and health status.
  
  
  
  Low-income adults with Medicaid, private insurance, and Medicare reported significantly better health care access and quality than uninsured individuals. Medicaid beneficiaries reported greater difficulty accessing specialists but less risk of high out-of-pocket spending than those with private insurance. For other outcomes, Medicaid and private coverage performed similarly.
  
  
  
  Low-income adults with insurance report significantly greater access and quality of care than uninsured adults, regardless of whether they have private or public insurance. Access to specialty care in Medicaid may require policy attention.
  
  
  
  Many states are still considering whether to expand Medicaid under the Affordable Care Act and whether to pursue alternative models for coverage expansion. Our results suggest that access to quality health care will improve under the Affordable Care Act's coverage expansions, regardless of the type of coverage.
authors.affiliation: Kevin H. Nguyen and Benjamin D. Sommers are with the Health Policy and Management Department, Harvard T. H. Chan School of Public Health, Boston, MA. Benjamin D. Sommers is also with the Department of Medicine, Brigham and Women's Hospital, Boston.
authors.forename: Kevin H
authors.initials: KH
authors.lastname: Nguyen
authors.affiliation: Kevin H. Nguyen and Benjamin D. Sommers are with the Health Policy and Management Department, Harvard T. H. Chan School of Public Health, Boston, MA. Benjamin D. Sommers is also with the Department of Medicine, Brigham and Women's Hospital, Boston.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Sommers
mesh_terms: D000328:Adult; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult