The voices of Urban Institute's researchers and staff
July 26, 2012

Obamacare holds promise for helping uninsured adults

July 26, 2012

With conversation and debate still surging about the Supreme Court decision to uphold Obamacare, a logical next question might be: will simply covering more people actually improve things? A recent study suggests the answer is “yes.” The Urban Institute and the University of California San Francisco evaluated adult coverage expansion in San Mateo County, California and found encouraging results.

In an effort to increase access to high-quality healthcare for its uninsured and underinsured adults—the same population that stands to benefit most from state Medicaid expansions under Obamacare—San Mateo County embarked on a comprehensive redesign of the health care delivery and long-term financial sustainability of its health system.

Reports from participants in the comprehensive evaluation include:

  • Large increases in having a usual source of care (a 48 percentage point increase).
  • Increases in having a doctor visit in the past 12 months (a 28 percentage point increase).
  • For those with chronic conditions, increases in routine care for their condition (a 36 percentage point increase).
  • A reduction in the in the share of participants reporting losing a day or more to mental or physical health problems (a 6 percentage point decrease).
  • High levels of satisfaction with the quality of healthcare received.

There were also some notable challenges. San Mateo participants reported long waiting periods to schedule visits and see health care providers. And this, combined with economic challenges resulting from the latest recession, led to an increase in demand for the county’s emergency services.

Overall, findings from the evaluation show that merely expanding coverage isn’t enough. It is also necessary to expand the supply of preventive, primary, and specialty care services, as well as to improve the quality and efficiency of services through systems redesign. Study authors conclude that strong leadership and a collective culture of innovation positioned San Mateo for success on these counts, even in the face of economic recession.

So perhaps the real question is, how can the lessons learned in one California county be applied across the state, and perhaps the entire country?

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