BREAKING: Stunning Results: Medicaid Does Not Improve Physical Health
In 2008 Oregon expanded its Medicaid program on a limited basis to 30,000 people who were selected through a lottery system out of 90,000 who wanted to enroll. A preliminary analysis found that Medicaid coverage improved access to care and perceived wellbeing for those selectively enrolled. But it was too early to assess the impact on health. Now, a new follow-up report in the New England Journal of Medicine reveals a stunning finding: the program apparently is having no effect on physical health!
Those selected to enroll increased their use of medical care. For example, new Medicaid enrollees were more likely to be diagnosed for diabetes and to take diabetes medication. However, this did not result in better control for their diabetes. Moreover, researchers also found Medicaid did not improve detection or control of high blood pressure or high cholesterol:
Medicaid coverage did not have a significant effect on measures of blood pressure, cholesterol, or glycated hemoglobin. Further analyses involving …those who reported receiving a diagnosis of diabetes, hypertension, a high cholesterol level, a heart attack, or congestive heart failure before the lottery … showed similar results…
“CONCLUSIONS
This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.”
Well, now the question becomes, is the reduced depression worth all this money? I think that it could have been better spent elsewhere…
This is incredible.
This undercuts the whole rationale for ObamaCare.
John Goodman is quoted on the study in the LA Times, starting paragraph 13:
http://capsules.kaiserhealthnews.org/index.php/2013/05/expanding-medicaid-didnt-lead-to-big-health-gains-in-oregon-study-finds/
And Devon Herrick is cited in the Kaiser Health News story toward the end:
http://capsules.kaiserhealthnews.org/index.php/2013/05/expanding-medicaid-didnt-lead-to-big-health-gains-in-oregon-study-finds/
What I find the most distressing is that many of the news outlets I’ve seen report on this study completely ignored all the poor results. The New York Times put a positive spin without hardly mentioning the program didn’t improve health. The New York Times article was titled Study Finds Expanded Medicaid Increases Health Care Use. By contrast, Slate ran the article Bad News for Obamacare. These two headlines were reporting on the same study!
Well, if these were healthy childless adults, Medicaid wouldn’t make that much difference anyway, would it?
I am afraid this is a mis-aimed shot across the bow.
Medicaid recipients are poor, and they lead very disorganized lives. (Call this their own fault or the fault of society, it is still true.) Many recipients live in a culture of poverty where nothing is regular, least of all keeping doctor appointments and taking all medications.
What Medicaid does accomplish is to give them some care and to save them a whole lot of money. Medicaid also helps doctors and clinics get paid something instead of nothing.
Medicaid is an economic program not a health program.
This study needs to be long term to be valid. This is a usage study which of course would go up. We need to see the mortality rates for all these groups to determine if the medical care was adequate.
I disagree once again. Medicaid may not improve mortality at all. A Medicaid recipient who gets blood pressure meds for free can still be shot by a violent husband, or drink too much, or eat a horrible diet. Or just have a broken heart, which of course can happen in any income class but the poor are not immune.
I am actually opposed to any analysis that measures health care by mortality rates.
This is done by liberals and conservatives alike. Besides a massive confusion of correlation and causation, I think it leads to America’s willingness to spend gargantuan amounts of money to delay death by just a year or two.
Well, if not giving the poor access to health care doesn’t improve health, lets go further. Eliminate the entire health care system, no more doctors, hospitals, all of it.
@Diogenes–do you really believe that people in the United States who are “poor” and not on Medicaid lack access to health care in the United States?
I said it in the above post I’ll say it here. Does insurance exist as a preventative? Do we get car insurance to prevent car accidents? Or homeowner’s insurance to prevent fire?
Health insurance doesn’t exist to make us healthier, it’s there to prevent us from going bankrupt when we get sick. It’s there to make sure someone pays for our medical expenses, rather than having them shifted onto the uninsured, as happens now when someone is admitted under EMTALA.
Did medicaid prevent bankruptcy? Did it pay bills when people got sick? Yes? Then it worked. Who the hell thinks health insurance makes us healthier?
Oh, I did forget one thing. The extensive literature that suggests when people do get sick, including Atul Gawande’s study on trauma victims, the uninsured receive poorer care and are more likely to die. It’s very unlikely any study not specifically dedicated to such a comparison of hospitalized patients would be powered to see such an effect. You need to look at trauma populations, or hospital admissions themselves of course. But there are instances in the literature that show the uninsured may be treated differently.
It’s not surprising that this was not replicated in this instance, when looking at a healthy population as a whole, it’s very difficult to see these effects. In Gawande’s study it required > 600,000 trauma patients. Still, the point of insurance isn’t to prevent one from being treated differently or to make you more healthy, it just speaks to the sad fact that our medical system is so dependent on such reimbursements that such patients are likely treated differently based on insurance status. Or maybe even not, maybe the uninsured as a class lead unhealthier lifestyles. But that’s besides the point.
Insurance doesn’t exist to make us healthy. Insurance exists to protect us from financial ruin.
Right on, Mark.
It is not hard to find well-insured segments of the population who have very good coverage and yet are very unhealthy.
Look at most school districts — enormous numbers of claims.
Of course some of the extra claims are due to more diseases being discovered through well-insured diagnostic tests.
Mark, you’re wrong. Medicaid’s “purpose is to improve the health of people who might otherwise go without medical care for themselves”. That’s straight from the Medicaid website. Therefore, this study shows – without case for argument – that Medicaid has failed in Oregon.
John – I’ve read the NEJM article, and get your point. But it seems to me that to infer, as you do (and the authors do as well), that the purpose of Medicaid is to improve health is simply wrong. Medicaid is an insurance program, not a health improvement program. And like any insurance, whether publicly-supported or private, it’s intended to mitigate against the risk of potentially catastrophic financial cost or loss. The study indicates that Medicaid has done that for the Oregon group (and, not surprisingly has, perhaps as a corollary, also reduced depression among the group). Car insurance doesn’t help you drive better or buy a more upscale ride; homeowner’s insurance doesn’t help you feather your nest. So why should health insurance, whether government-provided or privately-purchased, be expected to make you healthier?
One of the main purposes of both Medicare and Medicaid — since 1965, when they passed– was to pay doctors and hospitals something for what they used to do for free.
Why did we think that either program would improve health, which is environmental in nature?
Gabriel I said it in the other thread too, I don’t care what their stupid website says. Every health insurance company tries to sell you some damn line that they care about your health, that they’ll make you healthier, feel better, and it will rain puppies in the future. It’s besides the point.
Health insurance exists for financial protection, not health protection. If you want to be healthier, join a gym, eat right, stop smoking, lose weight. Health insurance will make zero difference for your health. If you don’t want to go bankrupt when something does go wrong, buy health insurance, get medicaid, cover your ass.