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Medicaid is expensive, but what is it worth?

Published July 18, 2012 9:17 am

Health reform • Utah's policy debate has shifted from covering the uninsured to curbing spending.
This is an archived article that was published on sltrib.com in 2012, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Expanding Medicaid would cut Utah's ranks of uninsured nearly in half.

Doing so would cost a pretty penny — billions in mostly federal dollars over the next decade — a point hammered on by state lawmakers at a Health Reform Task Force meeting last week.

But is there any upside to such spending? What is the value of giving 139,000 mostly working poor adults access to routine medical care?

"No one is asking that. I wish they would. It would return a little humanity to the discussion and help us remember we're talking about real people," said Lincoln Nehring, senior health policy analyst at Voices for Utah Children.

Blame the lagging economy or bitter political divide. But the health policy debate in this country has shifted.

Just seven years ago, then-Gov. Jon Huntsman was vowing to halve Utah's uninsured. He weighed, and abandoned, a fix championed by fellow Republican Mitt Romney, then governor of Massachusetts — the framework upon which the Affordable Care Act was built.

Since then, Utah's uninsured rate has grown and leaders have moved on. Their focus now: controlling unreasonable health costs and spending.

States are strapped for cash, but budgetary pressures don't wholly explain the shift, said University of Utah law professor Leslie Francis. An expert in health law, she believes that angst over the proper role of government, fanned by arch-conservatives, also plays a role.

"The tea party person who said, 'Keep your government hands off my Medicare,' obviously unaware that Medicare is a government program, captured this perfectly for me," Francis said.

Lawmakers meet again Wednesday to discuss the next steps after the Supreme Court upheld federal health reform. They'll mull employer penalties, tax credits and the "R's" of insurer regulation — reinsurance and risk adjustment.

Covering the uninsured isn't on the agenda, and the benefits of such a move are not easily quantified.

Consider Oregon, which in 2008 opened Medicaid to 10,000 of its uninsured under a lottery. In the first year, lottery winners reported improved health and well-being, according to a study by the National Bureau of Economic Research. They were happier and less likely to have medical debt despite more visits to the doctor.

But that translated to more spending, a 25 percent annual increase, the study showed.

It remains to be seen if better access to preventive care improves people's health and reduces spending. Researchers will follow lottery winners two more years to find out.

"The economics of health care change when you cover people. They use more care, but they use care differently," said Nehring. "It's hard to attach a dollar value to a happier, healthier population. Does productivity increase? Does Utah become a more desirable place to work and live? Do kids stay in school and learn better?"

For families in crisis, however, the calculus is simple.

Rachel Johnson, of Riverton, has one word for Medicaid: priceless.

Five months after her husband was laid off from his job driving an armored truck, Johnson learned she was pregnant with her third child. Uninsured and with no income, the family enrolled in Medicaid, which paid for Johnson's delivery and the follow-up care required by her newborn son, who was diagnosed with a rare, sometimes-fatal, metabolic disorder.

Johnson isn't one to write letters to Congress, and she's not sure how the health law or Medicaid expansion applies to her. But she bristles when friends make rash judgments about people on public assistance.

"I tell them flat out, my husband lost his job. We work hard and we're mindful of our finances. But because of Medicaid we didn't lose our house. My husband was able to go back to school and now works as a medical assistant," she said.

kstewart@sltrib.com

Twitter: @kirstendstewart —

If you go

I The Utah Legislature's Health Reform Task Force meets Wednesday at 9 a.m. in Room 30 of the House Buildingat the Capitol.