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April 14, 1999

Medicaid and Children's Access to Care—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(14):1273-1274. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-14-jac90002

In Reply: We appreciate Dr Kaestner's interest in our article but disagree with his assessment and conclusions. The main point of our study was "to understand how effective Medicaid has been in improving access to and use of health services for children in poor families." The comparisons made to answer this question are irrefutably valid. Medicaid as a program will always struggle with the additional disadvantages associated with poverty, and therefore it needs to do more than private plans to ensure access to care to the people it is intended to serve. Comparing poor children with Medicaid to nonpoor privately insured children as we did holds Medicaid to a higher standard than comparing them with other poor children with private insurance as suggested by Kaestner. His comparison would hold Medicaid to a lower standard and would treat the income gaps in access to care as acceptable. The fundamental disagreement appears to be over the interpretation of Medicaid's goals: is Medicaid intended simply to overcome the barriers associated with lack of insurance, or is it also charged with overcoming the barriers associated with poverty?