Medicaid – a Placebo for the Poor

Many GOP governors have been criticized for refusing to participate in the wild and ill-conceived expansion of the Medicaid program under Obamacare. There is good reason. While the expansion is underwritten by the Federal government in the near term, in the out years the states will be forced to either have their budgets consumed by Medicaid or take the politically difficult step of raising the eligibility requirements to pre-Obamacare levels. The left has glommed onto this yet another example of the heartless GOP wanting to kill off the poor. For instance, this from Talking Points Memo:

Republican governors refusing generous federal funding to expand Medicaid under Obamacare will leave over five million low-income Americans without basic health benefits, according to a new study by the Kaiser Family Foundation (KFF).

Since the Supreme Court ruled Obamacare’s Medicaid expansion to be optional last summer,just 25 states and the District of Columbia have proceeded to implement expansion. Another 22 states have refused, while a handful still remain undecided. Unfortunately, poor Americans living in states that aren’t expanding Medicaid likely won’t be able to afford health insurance at all.

There is, however, a conservative critique to be made of Medicaid that has nothing to do with money or politics. There is no evidence that it is better than no coverage at all.

Recently, the Oregon Health Insurance Experiment has provided uniquely powerful evidence about the impact of Medicaid coverage on uninsured adults. The evidence is compelling because the study is a randomized controlled trial (RCT), the gold standard in research design. Taking advantage of a lottery held in Oregon in 2008 to allocate a limited number of new Medicaid “slots” for low-income, uninsured nonelderly adults, a team of researchers gathered data on access, utilization, and clinical health measures for both the adults who gained Medicaid through the lottery and the adults who did not. Two rounds of findings have been published in the New England Journal of Medicine, which can be summarized, in part, as follows:

What follows are the top line summary statements. You can read the back-up discussion at the link.

  • Medicaid increased access to care and health care use, and improved self-reported health.
  • Medicaid improved adults’ mental health markedly; Medicaid’s impact on physical health remains inconclusive.
  • Medicaid virtually eliminated catastrophic medical expenses.

While the recipients used more services, felt better about themselves, and avoided catastrophic medical expense, the single factor that was “inconclusive” was their actual health.

More details here.

This entry was posted in Constitutionally Limited Goverment, Fiscal Responsibility, Free Markets, Health Care and tagged , , , . Bookmark the permalink.

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