Reimbursement rates are so low, and billing the program so complicated, that it is hard for internists to get beneficiaries access to specialized care or timely interventions. For  patients, many of whom are uneducated or don't speak English, Medicaid is replete with paperwork, regulations and rejections that make the program hard to navigate, writes Dr. Scott Gottlieb, a resident fellow at the American Enterprise Institute and a former senior official at the Centers for Medicare and Medicaid Services.

Accumulating evidence shows that Medicaid recipients' poor health outcomes aren't just a function of their underlying medical problems, but a more direct consequence of the program's shortcomings.  Take the treatment of serious heart conditions:

• One study published in the Journal of the American College of Cardiology (2005) found that Medicaid patients were almost 50 percent more likely to die after coronary artery bypass surgery than patients with private coverage or Medicare. (The authors suggest this may be a result of poorer long-term, follow-up care.)
• Another study in the journal Ethnicity and Disease (2006) showed that elderly Medicaid patients with unstable angina had worse care, partly because they were less likely to get timely interventions or be treated at higher quality hospitals.
• Three other recent studies showed that Medicaid patients presenting with heart attacks or unstable angina received cardiac catheterization less often than Medicare or private paying patients; this procedure to open blocked heart arteries has become standard care, with ample evidence showing it improves outcomes.

The same trends can be observed in other diseases.  For example, a study of adults with cancer published in the journal Cancer (2005) found that patients on Medicaid were two to three times more likely to die from the disease.