CEO Post: Response to Oregon Medicaid Study
CEO Blog Post
Kansas City Star columnist Dave Helling wrote (May 7, 2013) about findings of a New England Journal of Medicine study of a Medicaid expansion experiment in Oregon that are being called out by health reform opponents as proof that Medicaid doesn’t work. The debate that has flared up highlights the difficulties of distilling scientific studies into sound bites – they paint a partial picture based on selected results.
In 2008, the state of Oregon had enough money to expand Medicaid to about 10,000 additional people. However, more than 90,000 applied. The state held a lottery (only in America!) and created an unprecedented randomized controlled experiment in which researchers could compare the health, use of services, financial status, and other characteristics of those who received Medicaid with a group that remained uninsured.
After two years, those who gained access to Medicaid had much lower incidence of depression and higher use of physician services, prescription drugs and preventive care. More people were diagnosed with diabetes and received medication to control it. In addition, those covered by Medicaid had much lower out-of-pocket costs, and were less likely to experience catastrophic health costs. The findings also showed, however, that those with high blood pressure, high cholesterol, and diabetes did not show significant improvement.
The study results were not as positive as Medicaid expansion proponents would have liked. However, the study didn’t prove that Medicaid is a failed program, as opponents would like for the public to believe.
Medicaid, like other health insurance programs, buys access to services, and while our country’s health care system isn’t always effective at producing good outcomes, insurance coverage is an essential element in obtaining health care. In that respect, the Oregon study showed that Medicaid does work. And we know from decades of research from organizations like the Institute of Medicine that having no coverage at all is linked to dire health consequences, most notably, premature death.
It is likely that those enrolling for the first time in Oregon’s expanded Medicaid program were probably sicker to begin with, having gone without access to preventative care and treatment for years. Two years may not be long enough to see significant improvements in cholesterol, blood pressure, and diabetes—chronic conditions that take years to develop and a lifetime to manage. Just ask anyone battling those diseases, insured or otherwise.
Brenda R. Sharpe, President and CEO
Read other views of the Oregon Medicaid study results:
“What Oregon Really Told Us about Medicaid,” New Republic, May 13, 2013
“Oregon’s Medicaid Experiment: Coverage is the First Step,” Health Affairs, May 2, 2013
“Study: Medicaid Reduces Financial Hardship; Doesn’t Quickly Improve Physical Health,” The Washington Post, May 1, 2013