State officials around the country have spent the last few months bending over backwards finding reasons to accept Medicaid expansion for low-income Americans, refuse it, or try to create a publicly-funded privately managed hybrid. But what do these choices mean for real people?
A groundbreaking new study published on Wednesday in The New England Journal of Medicine offers some answers about what's at stake in the Medicaid expansion debate.
The Oregon Health Study tracked the health and financial outcomes of thousands of low-income residents of Oregon who received access to Medicaid with an identical population that did not. On the plus side for advocates of expanded Medicaid coverage, the study found that enrollees had less trouble paying their bills and saw significant improvements in mental health outcomes, with rates of depression falling by 30 percent, compared those in the control group. Low-income Oregonians who hadn't seen a doctor in years finally had access to care, and in fact, "adults covered by Medicaid increased their use of a broad number of health services, like mammograms and cholesterol tests."
Anti-Affordable Care Act organizations, however, are jumping on the part of the study that found Medicaid coverage did not make those adults much healthier, at least within the two-year time frame of the research, judging by their blood pressure, blood sugar and other measures. It did not significantly reduce the prevelance of hypertension, high cholesterol, Cato Institute health policy director Michael Cannon told The Washington Post "This throws up a huge stop sign in front of the Medicaid expansion. . . The benefits are highly questionable.”
While the lack of positive physical health outcomes within the two-year timeframe are troubling, it's also important to keep in mind that not all participants in the study, in either group, had the same baseline of health care prior to the study. Some likely hadn't been to the doctor in years because they couldn't afford it.
Two years might just not be enough time to repair a lifetime of damage. In fact, the lead study author, Katherine Baicker a professor at Harvard University, noted that "while this study showed few short-term physical health gains, that likely says little about improvements that could occur in the future." Ultimately, Baicker told The New York Times, “They go to the doctor more often, they visit the hospital more often, they use more prescription drugs, they are more likely to use preventive care."
While he called the results "dissappointing," Zeke Emanuel, a former health policy advisor to Obama may have put it best, noting, "This says there are benefits to providing Medicaid but that we also need to fix the system.“ The Oregon Study may not have revealed that Medicaid is perfect, but the gains in mental health outcomes, the rise in doctor visits and preventive care, not to mention the amount of money enrollees saved on medical bills, are all reasons for supporters of Medicaid expansion to be at least cautiously optimistic.
Health improvements don't happen over night, but that's no reason not to invest in programs for low-income Americans, that will at least set them on the path to better habits, and eventually better health.