Original pargraph in full:
Even prior to Obamacare, Medicaid stood in desperate need of reform. In many states, low physician-reimbursement rates result in poor access for beneficiaries. Medicaid beneficiaries have higher rates of emergency-room usage than uninsured patients, and a landmark study from Oregon found that they showed no measurable improvement in health outcomes after gaining Medicaid coverage.
Now, a look in depth.
> Even prior to Obamacare, Medicaid stood in desperate need of reform.
"Desperate" -- no. "need of reform" -- yes.
In many states, low physician-reimbursement rates result in poor access for beneficiaries.
This is an interesting claim, because it has a long history. The simplified argument is basic supply and demand economics: if doctors are forced to lose money by treating welfare recipients (a dubious claim, begging the question), there will be fewer doctors. This is how the American Medical Association (AMA) viewed Truman's attempt at "socialized medicine," capitalizing on anti-communist sentiment at the time, and endorsing a separate plan that subsidized private insurance (http://www.pbs.org/newshour/updates/november-19-1945-harry-truman-calls-national-health-insurance-program/ ). It took twenty more years before Medicare and Medicaid were signed into law, which happened in 1965.
The AMA's claims that government discounted healthcare would result in worse access is a real concern, but one hardly supported by evidence. An early study of the effects, a 1979 article (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4191066/ ), outlines that there are multiple conflicting interests to providing 1) good health care, 2) at an affordable cost, 3) such that it encourages physicians to participate in the program, 4) in a wide number of geographic areas (geography is an important technical point related to physician reimbursement). But overall, the authors found, Medicaid and Medicare had increased access to healthcare.
Despite the difference between private and "public" payment received for the same service (for instance, in Texas https://www.texmed.org/June16Journal/ ), and despite what doctors self-report (e.g. http://link.springer.com/article/10.1007%2Fs10754-014-9152-y which further enforces the AMA narrative above), evidence consistently shows Medicaid and Medicare increases access to health care. The Kaiser Family Foundation (KFF) has a good summary from 2013 of all these points and more ( http://kff.org/report-section/what-is-medicaids-impact-on-access-to-care-health-outcomes-and-quality-of-care-setting-the-record-straight-on-the-evidence-issue-brief/ ). One other finding, from a 2005 study, was that while higher Medicaid reimbursement fees lead to slightly higher physician participation, the relationship is surprisngly weak and there are actually a large number of factors that define doctor participation (http://journals.sagepub.com/doi/abs/10.1177/1077558705281061 ).
Medicaid beneficiaries have higher rates of emergency-room usage than uninsured patients (http://www.nejm.org/doi/full/10.1056/NEJMp1609533 ), and a landmark study from Oregon found that they showed no measurable improvement in health outcomes after gaining Medicaid coverage (http://www.nejm.org/doi/full/10.1056/NEJMsa1212321 ).
The KFF summary linked above actually addresses both of these claims. As mentioned in the source article, there are various explanations for this behavior, such as the doctor's office telling a patient to go to the emergency room. I fail to see why this is a problem. The second claim is an intentional falsehood (ahem, lie) that "health outcome" does not include mental health. Here are the concluding remarks from the second source article:
Despite these limitations, our study provides evidence of the effects of expanding Medicaid to low-income adults on the basis of a randomized design, which is rarely available in the evaluation of social insurance programs. We found that insurance led to increased access to and utilization of health care, substantial improvements in mental health, and reductions in financial strain, but we did not observe reductions in measured blood-pressure, cholesterol, or glycated hemoglobin levels.