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Gynecologists ordered fewer preventive services for women who were insured by Medicaid than for those with private coverage, a recent study found.

The study by researchers at the Urban Institute examined how office-based primary care practices provided five recommended preventive services over a five-year period. The services were clinical breast exams, pelvic exams, mammograms, Pap tests and depression screening.

The study used data from the National Ambulatory Medical Care Survey, a federal health database of services provided by physicians in office-based settings. It looked at 12,444 visits to primary care practitioners by privately insured women and 1,519 visits by women who were covered by Medicaid between 2006 and 2010. That difference reflects the fact that the share of women who are privately insured is seven times larger than those on Medicaid, the researchers said. Pregnancy-related visits and visits to clinics were excluded from the analysis.

Overall, 26 percent of the visits by women with Medicaid included at least one of the five services, compared with 31 percent of the visits by privately insured women.

As for specific preventive services, the study found “strong evidence” that visits by Medicaid patients were less likely include a clinical breast exam or a Pap test, says Stacey McMorrow, a senior research associate at the Urban Institute’s Health Policy Center and the study’s lead author. The differences for depression screening weren’t statistically significant, and once patient characteristics such as age, race and home address were taken into account weren’t significant for mammograms or pelvic exams either.

For example, 20.5 percent of visits by privately insured women included a clinical breast exam, and 16.5 percent of visits included a Pap test. But the percentage of Medicaid-insured visits that included those services was only 12 percent and 9.5 percent, respectively. (The differences narrowed but remained statistically significant when adjusted for patient characteristics.)

The Medicaid-insured women were not necessarily receiving lower quality care, according to the study. They may have been receiving additional care at a community health clinic or from a nurse practitioner, for example, but the study only examined physician services provided in office-based practices.

In addition, privately insured women may have been receiving services more frequently than recommended. For example, current guidelines generally recommend a Pap test to screen for cervical cancer every three years. But if a patient asks for a Pap test every year the doctor may provide it, McMorrow says.

In addition, private insurers generally pay providers better than does Medicaid, sometimes significantly better, she says: “Where providers are getting reimbursed better, they’re going to provide services more frequently.”

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Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

President Barack Obama called on Republicans Wednesday to find a bipartisan way to fix problems in the nation’s health care system rather than continue to fight over the health law.

“Part of what I’m hoping is with the Supreme Court case now behind us what we can do is … focus on how we can make it even better because it’s not as if we’ve solved all the problems in our health care system,” Obama said in remarks at an elementary school in Nashville, Tenn. “America still spends more on health care than any other advanced nation and our outcomes aren’t particularly better.”

In a 6-3 ruling, the high court last week rejected a challenge that would have ended federal premium subsidies in at least 34 states for individuals and families buying insurance through the federal government’s online marketplace. Such a result would have made coverage unaffordable for millions and created price spirals for those who kept their policies, many experts predicted.

While the president’s law survived its second Supreme Court test in three years, the decision by no means has ended the legal and political assaults from opponents. Several GOP presidential hopefuls and House Speaker John Boehner, R-Ohio, among others, have continued to call for the law’s repeal.

Tennessee Rep. Diane Black, a Republican, took a swipe at the law and the president’s visit, suggesting that Obamacare was putting “the squeeze” on families in her district. She noted that the state’s largest insurer, BlueCross BlueShield, is requesting a “whooping 36 percent rate hike” on the health law’s exchange next year “despite the president’s repeated promise that this law would save Americans an average of $2,500 per family, per year.”

In his remarks, the president said a lot of waste remains in the nation’s health care system and quality “isn’t always where it needs to be,” he said. “So my hope is that on a bipartisan basis, in places like Tennessee but all across the country, we can now focus on what have we learned? What’s working? What’s not working?”

Obama’s appearance Wednesday was part of a renewed focus on states such as Tennessee that have not expanded Medicaid, the shared federal-state health insurance program for low-income residents. Under the law, states have the option to expand Medicaid eligibility to individuals who earn about $16,000 a year — with the federal government covering much of the cost. But 21 states have not done so because of political opposition to the law.

Federal officials and health law supporters see Tennessee as a state that might move off that list. Gov. Bill Haslam, a Republican, proposed a program called Insure Tennessee that would use the federal Medicaid expansion funding to help provide insurance to 288,000 low-income Tennesseans. The plan was twice defeated in state Senate committees. Following the court decision, advocates have called for the governor to renew his efforts to pass the plan.

“There’s something that can be done but it’s going to be at the state level,” Obama said to an audience question on the issue, urging lawmakers to find “a uniquely Tennessee solution to the problem. “It is unfortunate that getting this thing done got so political. Washington is kind of a crazy place. But that doesn’t mean that every place has got to be crazy.”

“There’s something that can be done but it’s going to be at the state level,” Obama said to an audience question on the issue, urging lawmakers to find “a uniquely Tennessee solution to the problem. … It is unfortunate that getting this thing done got so political. Washington is kind of a crazy place. But that doesn’t mean that every place has got to be crazy.”

Yet national poll results show the American public remains split over the health law. A Kaiser Family Foundation poll released Wednesday found 43 percent supporting the law and 40 percent in opposition, much as it has been for the past several months. (KHN is an editorially independent program of the foundation).

That split, however, does not extend to views about the court decision, however. Six out of 10 people questioned said they approved of the Supreme Court’s decision to uphold the law’s subsidies in both state and federally run exchanges, or marketplaces, while about a third disapproved. Even among Republicans and those who dislike the law, about 3 in 10 say they backed the ruling.

The tracking poll was conducted from June 25 through June 29 among 1,202 adults ages 18 and older. The margin of error for questions of the overall public is +/- 3 percentage points.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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Tuesday would have been the last day of operation for 10 Texas clinics that provide abortion. But on Monday the U.S. Supreme Court, in one of its final actions this session, said the clinics can remain open while clinic lawyers ask the Court for a full review of a strict abortion law. Two dozen states have passed regulations similar to the ones being fought over in Texas.

Two years ago, when Texas passed one of the toughest laws in the country regarding abortion, the number of clinics offering the procedure dropped from 41 to 19. Amy Hagstrom Miller, chief executive of Whole Woman’s Health, has already closed two clinics in Texas because of the law and was about to close two more.

“Honestly I just can’t stop smiling,” Hagstrom Miller said. “It’s been so much up and down … so much uncertainty for my team and the women that we serve.”

The Texas law says doctors who perform abortions must have admitting privileges at a nearby hospital. But some hospitals are reluctant to grant those privileges because of religious reasons or because abortion is so controversial.

The law also requires that clinics meet the same standards as outpatient surgery centers. Those upgrades can cost $1 million or more.

“It’s an example of the rash of laws … that have taken a sneaky approach by enacting regulations that pretend to be about health and safety but are actually designed to close down clinics,” said Nancy Northrup, chief executive of the Center for Reproductive Rights, which is representing clinics in their fight to overturn the Texas law.

Supporters of the law say every woman deserves good medical care whatever the procedure.

“While we hope that she would not be compelled to choose abortion, we hope that her life would of course not be at risk should she choose to do that,” said Emily Horne of Texas Right to Life. “Pro-life does not just mean care for the life of the unborn child, it’s care for the life of the woman undergoing the abortion as well.”

The law has had a drastic effect in Texas, the country’s second most populous state, leaving most of the remaining clinics in major cities.

There’s just one clinic left along the Mexican border and one in far west El Paso – they were among the nine about to shut down.

If they had closed, the women there faced roundtrips of 300 miles or more to get an abortion.

Hagstrom Miller says all these clinic rules and the doctor restrictions are a deliberate strategy waged by anti-abortion groups. “They’re going state by state by state,” she said. “They can’t make it illegal, so they’re basically making it completely inaccessible.”

Other states that have passed similar laws are also facing legal challenges.

Emily Horne, of Texas Right to Life, says her group would welcome a legal review by the U.S. Supreme Court.

“With this case, issuing some more guidance on that could be very helpful for the pro-life movement in determining what courses to pursue, which laws they might pass in other states in the future.”

The clinics in Texas can stay open at least until the fall. If the court decides to take the case, it would hear arguments in its next term that starts in October.

This story is part of a reporting partnership that includes Houston Public Media, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.