Friday, September 12, 2014

Oregon study: Does Medicaid matter?

"Medicaid doesn't make people healthier;  just look at the Oregon study."

I heard that comment a couple of times while I was reporting on Medicaid expansion,  from people supporting North Carolina's decision not to participate.

While I think that assessment is oversimplified,  I was intrigued to learn about Oregon's Medicaid lottery.  In 2008 the state randomly selected people to receive Medicaid coverage.  In the years that followed that provided a unique chance to study the role that coverage played in low-income people's health.

Image: Kaiser Health News
As you might expect, the results were complex and sometimes confusing.

Two years after the lottery,  people with Medicaid were more likely to have been diagnosed with diabetes and placed on medication.  But there was no significant improvement in their blood sugar levels,  which would have been a sign of ultimate success. There was also an increase in cholesterol monitoring,  but no significant differences in blood pressure or cholesterol between the Medicaid and non-Medicaid groups.

On the other hand, people with Medicaid were less likely to be diagnosed with depression and reported their own health as better.

On the financial front,  people who got Medicaid were less likely to have unpaid bills sent to a collection agency, "which also benefits health care providers since the vast majority of such debts are never paid," a National Bureau of Economic Research report notes.  But getting Medicaid also increased the rate of emergency room care for non-emergency ailments,  one of the least effective ways of getting treatment.

I don't think that justifies a conclusion that Medicaid does no good,  but the folks who raise that issue make an important point:  Just getting people covered isn't really the goal.  We want better health,  especially when we're spending billions of dollars.  And it's smart to take a close look at whether any reform brings the hoped-for results.

If you want to learn more about the Oregon experience,  here's a New England Journal of Medicine article and a 2013 Kaiser Health News/Washington Post interview with one of the Medicaid lottery winners.

"My blood pressure is still not perfect, but over the last two years I have stopped taking two different blood pressure medicines and am only taking half of a third,"  Mary Carson told interviewer Jordan Rau.  "That is a health improvement but it doesn't necessary show up in the study. My blood sugar is not perfect, but it's more consistently in the right zone. But according to the study, I haven't improved."