

A Texas health clinic serving low-income patients. (AP Photo/Eric Gay)

The Medicaid program, already the nation's largest insurer, has quickly added millions to its rolls since the start of Obamacare's coverage expansion. And it appears that Medicaid enrollees are generally happy to have coverage, though many are encountering roadblocks to receiving the care they want, according to new research that provides one of the earliest insights into people's experiences under the expanded health insurance program for low-income Americans.

The new insight comes from the research firm Perry Undem, which held six focus groups in Chicago, Denver and Portland, Ore., over the summer. Focus group participants were all newly enrolled in Medicaid this year, although many have also had past experience with private insurance or been previously enrolled in Medicaid before dropping off.

The findings, which were presented on Friday to an independent panel advising Congress on Medicaid issues, can't fully capture the national experience under the newly expanded program. Even across these three cities, Medicaid enrollees' experiences have differed in important ways — access to care was much less of an issue in Denver, for example. The findings are still instructive, though, for those trying to understand what having new Medicaid coverage actually means.

"We really want the personal stories, the human face of what's going on with new Medicaid enrollees," said Mike Perry, partner with Perry Undem.

Before obtaining new coverage, most people in the focus groups said they delayed medical care while they had been uninsured, and some in the focus group said they're facing medical debt for care that they couldn't delay. Preventive care, in particular, had been a challenge for this group – many said they hadn't received a checkup in years.

All the study participants said they feel better off with free or low-cost Medicaid coverage, and they worry less about being able to afford bills or see a doctor for ongoing health problems. The majority said they've already used their coverage and feel healthier because of it.

Still, most said they didn't even know they were eligible for Medicaid — they went looking for coverage hoping to qualify for "something." They knew little about Medicaid before they enrolled, and they still didn't know about it much later. There's some confusion about what the program actually covers, and researchers found some feared receiving low-quality or limited care.

The enrollees' biggest problem has been finding a primary care doctor, which has been a major concern in the health policy community. A Health Affairs study found just one-third of doctors in 2011 would take new Medicaid patients, and this problem was greater in states with lower Medicaid reimbursement rates. It's also why the Affordable Care Act temporarily boosts traditionally low Medicaid reimbursement to primary care doctors as the program expands.

Some new enrollees in the focus groups said they had to call at least six practices to find a doctor, some had to choose doctors far from where they live, and some said they suspect providers are limiting how many Medicaid patients they'll take. Others said they weren't used to the process of finding a primary care physician, and others didn't try because they didn't see an urgent need to find one.

Other enrollees said finding a specialist or a dentist was even tougher — as has typically been the case in the Medicaid program. Enrollees also found unexpected limits to the dental care that was actually covered, which came as a "big disappointment" since enrollees especially wanted this coverage, Perry said.

Portland study group participants in particular had trouble receiving mental health-care services. They reported not being able to see a psychiatrist, instead having to rely on student counselors or receiving their medication through clinics.

Issues aside, the Medicaid enrollees said they'd rather have the coverage than not have it. They all said they would re-enroll in the program if they couldn't get other insurance over the course of the year, and they've been spreading the word to friends and family to sign up.

"They don't want to be uninsured again." Perry said.