Low-income people without health insurance are much less likely than low-income Medicaid enrollees to say they are in excellent health.

Avalere Health L.L.C., Washington, a health policy firm, has included that finding in a discussion of the effects that the Patient Protection and Affordable Care Act of 2011 (PPACA) may have on Medicaid and other public health programs in 2014.

If PPACA takes effect on schedule and works as supporters hope, it should lead to dramatic growth in Medicaid enrollment in 2014, when PPACA coverage expansion provisions start to apply.

Conventional health policy wisdom holds that uninsured people tend to need more medical care than otherwise similar people who have health coverage.

Avalere analysts tested that belief by comparing responses to the 2008 Medical Expenditure Panel Survey from low-income people with Medicaid and low-income people without Medicaid.

About 61% of the Medicaid enrollees reported being in excellent or very good health; 51% of the low-income uninsured participants reported being in excellent or very good health.

The percentage of low-income survey participants who reported being in poor health was the same for the Medicaid enrollee group and the uninsured group: 4.3%.

The percentage of uninsured survey participants who reported being in very good healthy was higher for the uninsured survey participants: 28% of the uninsured participants said they were in very good health, compared with 27% of the Medicaid enrollees.

But 34% of the Medicaid enrollees said they were in excellent enrollees, and just 24% said they were merely in good health; only 24% of the uninsured low-income participants said they were in excellent health, and 30% said they were merely in good health.

- Allison Bell

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