This week’s study of Oregon Medicaid recipients has quickly become a Rorschach test for how partisans and health policy wonks view the health care law.
To recap, that study compared the health care of the winners and losers of a lottery held by Oregon in 2008 to decide who could enroll in the limited spots in the state’s Medicaid program. The study’s nuanced results were reflected in the varied headlines in news stories. The Associated Press declared “Depression rates for uninsured dropped with Medicaid coverage” while Bloomberg News announced that “Medicaid coverage may not improve the health of poor in U.S.”
Bloggers took the discrepancies and ran with them.
The liberal Daily Kos, like many supporters of the health law, focuses on the finding that people with Medicaid were less likely to have crippling medical bills:
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.
The libertarian Cato Institute’s Michael Cannon says the study‘s lack of definitive proof of improved health should give governors more reason to turn down the law’s Medicaid expansion:
The Obama administration has been trying to convince states to throw more than a trillion additional taxpayer dollars at Medicaid by participating in the expansion, when the best-designed research available cannot find any evidence that it improves the physical health of enrollees. The [researchers] even studied the most vulnerable part of the Medicaid-expansion population – those below 100 percent of the federal poverty level – yet still found no improvements in physical health.
At the right-tilting American Enterprise Institute, James Pethokoukis says the results prove the health law’s promises were oversold.
Oh, the Medicaid recipients used more health care services and felt happier and experienced less financial hardship. Not insignificant impacts — but these were not the big health care selling points by Obamacrats. It’s like returning a lemon to an autodealer and having the sales guy talk up the car’s great air conditioning and the sound system. The researchers running the study are talking up those positive results, but that is just a game effort to turn lemons into lemonade.
Jonathan Cohn at the left-leaning New Republic asks whether conservatives “read the same study that I did?”
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.
At the Incidental Economist, Austin Frakt and Aaron Carroll note that the study’s measures of people’s health were not comprehensive enough to draw definitive conclusions:
Most of these measures are still process measures. A1C is a marker. So is cholesterol. Did real outcomes change? Patient centered ones, like healthrelated quality of life, did. Did mortality? Did morbidity? We still don’t know. That would take more time to see.
In a post titled “Misunderstanding Oregon,” Harvard’s Dr. Ashish K. Jha believes the study illustrates that “healthcare isn’t health; and the missing link is Quality”:
The Affordable Care Act makes a big effort to improve access, but does less on cost and little on quality. That’s unfortunate. Oregon reminds us that if we want to improve the health of the population, we will have to make real and concerted efforts to ensure that people are receiving high-quality care. We can’t just improve access and think that our job is done – in fact, its just the beginning.
Time’s Kate Pickert lays the responsibility for Oregon’s limited improvements at the feet — and kidneys — of the patients themselves:
Patients need to be more involved in managing their health. Chronic conditions like hypertension and diabetes have a lot to do with weight, diet and adherence to medication regimens, which patients can control. Without a patient’s commitment to carefully manage these factors, the best and most available doctor on the planet won’t make much difference in the overall health of many people.
Yes, what do the patients have to say for themselves? Robert’s Stochastic thoughts blog highlights an online opinion from an actual patient who says he was one of the winners of Oregon’s lottery. The first-hand account, rare in all the coverage, is worth a lengthy excerpt:
Stepping back into healthcare was like hopping on a merry-go-round. The doctor wanted to do test after test to come up with baselines for me, and I had a hard time showing up at the lab, I hadn’t been going to the doctor to find out new things about what was wrong with me. A huge part of living without insurance is not thinking about your high blood pressure damaging your kidneys. It takes a while to change that. It took me 6 months to change my level of co-operation with my doctor, and she said I was faster than many. Most people got into the groove about their 2nd physical. Then we had year-to-year values for blood tests and weight and blood pressure. Those numbers getting better helped. I lost 40 pounds the first year, regained 15, and lost another 10 the next year. Now my doctor wants me to try for another 10 pound loss. I have gone from 3 blood pressure medicines to 1, and that’s at a half dose. This whole time my blood pressure stayed the same, but dropping 2 pills and keeping the same score is a health upgrade. My blood sugar is still pre-diabetic, but diabetes is a progressive disease. If you keep your blood sugar at the same level for 2 years, you are making progress with managing diabetes. The study would have found me to make no progress, but my doctor thinks I have improved.