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A major new Medicaid study has become a hot political story in the way only a story about improving the lives of low-income people could: Republicans are using it to argue that expanding health care is a bad thing. The study comes from the New England Journal of Medicine (subscription only), reporting on health outcomes from a two-year experiment in Oregon. A few years ago, the state had enough funding to increase Medicaid eligibility to 10,000 more residents, and they held a lottery to pick those lucky souls. This set up a pretty perfect study opportunity for researchers: compare the health status of those who applied and received Medicaid coverage against those who applied and didn't. The part the Right is seizing on is this:
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.
Because in two years Medicaid coverage didn't show significant improvements in the measured outcomes—"blood-pressure, cholesterol, and glycated hemoglobin levels"—those on the Right arguing against Medicaid expansion in Republican states are crowing that they were right all along, that Medicaid coverage doesn't do any good and thus leaving people uninsured makes more sense than extending coverage. Which, as Jon Cohn argues, ignores most of the real lessons of the first two years of this experiment.
The big news is that Medicaid virtually wiped out crippling medical expenses among the poor: The percentage of people who faced catastrophic out-of-pocket medical expenditures (that is, greater than 30 percent of annual income) declined from 5.5 percent to about 1 percent. In addition, the people on Medicaid were about half as likely to experience other forms of financial strain—like borrowing money or delaying payments on other bills because of medical expenses. [...]

The other big finding was that people on Medicaid ended up with significantly better mental health: The rate of depression among Medicaid beneficiaries was 30 percent lower than the rate of depression among people who remained uninsured. That’s not just good health policy. That’s good fiscal policy, given the enormous costs that mental health problems impose on society—by reducing productivity, increasing the incidence of violence and self-destructive behavior, and so on.

There are any number of plausible explanations for why the study didn't find significant physical health improvement: the relatively short study period for significant health effects to occur; the relatively small sample size; the number of people within that sample who had issues with blood pressure or cholesterol or blood sugar to be improved upon. The study authors acknowledge that: "Nonetheless, our power to detect changes in health was limited by the relatively small numbers of patients with these conditions; indeed, the only condition in which we detected improvements was depression, which was by far the most prevalent of the four conditions examined."

The most prevalent condition—depression—did improve and improved dramatically, which is not only a good thing but a thing really worthy of spending federal dollars on. But here's what else the study didn't find: worse health outcomes. Expanding Medicaid to more people absolutely doesn't hurt public health. Extending the security of having access to affordable health care has absolutely improved the mental health and the financial security of the people who received it.

That's the point of health insurance: You get it for the peace of mind of knowing that catastrophic illness won't ruin you physically and financially. That shouldn't be reserved just for people lucky enough to a) have job-related health benefits, b) have enough money to buy their own insurance.

Originally posted to Joan McCarter on Thu May 02, 2013 at 12:43 PM PDT.

Also republished by Daily Kos.

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