The limits of Medicaid
By m. royce van tassell
In promoting Obamacare to Congress and the American public, President Barack Obama and other backers of universal insurance coverage frequently said that people lacking health insurance have worse health than those who have health insurance. As it turns out, the first meaningful study of that claim says there's little difference.
The New England Journal of Medicine has published a study by a group of Harvard and MIT researchers evaluating the physical and mental health impact of having Medicaid versus having no insurance. Because of a unique program in Oregon, they were able to conduct a random control test of how Medicaid affected mental and physical health in about 12,000 Oregonians.
One group of 6,400 Oregonians applied for and got into a 2008 expansion of Oregon's Medicaid program. Another nearly demographically identical group of 5,800 Oregonians applied for and failed to get into the same expansion. Remarkably, the MIT/Harvard researchers found no statistically significant evidence that those who got into Medicaid were physically healthier than those who did not get into the program.
Specifically, the researchers write: "We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5 percent or higher.
"Medicaid coverage decreased the probability of a positive screening for depression, increased the use of many preventive services, and nearly eliminated catastrophic out of pocket medical expenditures."
Hypertension, high cholesterol and average glycated hemoglobin are objective measures doctors routinely use to evaluate a patient's risk for stroke, heart attack and diabetes. According to this research, having Medicaid has no effect on how objectively healthy participants in the study were, along these dimensions.
To evaluate how important these findings are, recall that stroke, heart attack and diabetes are three of the most common preventable causes of death. Doctors routinely treat them with inexpensive, generic drugs, yet millions of Americans die from these diseases each year.
If access to health insurance for poor people (via Medicaid) increased the likelihood that many of these people would survive, the case to expand Medicaid would be much stronger. Unfortunately, that's not what the evidence shows.
Unsurprisingly, supporters of Obamacare are focusing on the study's other findings. However, those findings should surprise no one. When someone else (Medicaid) is paying the bill, participants went to the doctor more often. When someone else is paying, participants didn't have as many "catastrophic out of pocket medical expenditures." Those findings are as insightful as noting that the valley gets lighter when the sun comes up.
It is perhaps surprising that being on Medicaid makes people less likely to be diagnosed with depression. However, it's hard to believe that expanding Medicaid is the best way to combat depression.
This research is particularly valuable here in Utah, because the Legislature and Gov. Gary Herbert must decide whether to expand the state's Medicaid coverage, per the Supreme Court's Obamacare decision. If tens, perhaps hundreds of millions of dollars in additional Medicaid spending don't make Medicaid recipients healthier, perhaps there's a better, less expensive way to use that money.
M. Royce Van Tassell is vice president of the Utah Taxpayers Association and a member of Utah's Medicaid Options Working Group.