A new study about the effectiveness of Medicaid in Oregon is being cited by opponents of expanding Medicaid in Florida and elsewhere, who complain the government health insurance program for the poor is a waste of taxpayer money. In fact, the results are more nuanced and suggest there are positive benefits as well as areas that need more study. The findings that Medicaid recipients enjoy lower rates of depression, increases in preventive health care and gains in financial stability should not be so easily dismissed.
The Oregon study, reported in the May 2 online edition of the New England Journal of Medicine, is drawing national attention because it met exacting standards for social science research and seemed to suggest that people with Medicaid are no physically healthier than people without insurance. Oregon used a lottery system to give Medicaid to 10,000 additional poor adults. This allowed researchers to compare 6,300 people who were able to apply for Medicaid with 5,800 who didn't win the lottery.
What the researchers found after two years of study is that improvements for Medicaid patients suffering from diabetes, hypertension and high cholesterol were not significantly better compared with the uninsured. If the program doesn't make people healthier, critics ask, why should states add 16 million more people to the rolls?
The answer is twofold: First, the study's conclusions are not as firm as they appear because the sample included relatively few unhealthy participants. Just as with all health insurance, most people with Medicaid are fairly healthy. The researchers acknowledged that the small number of patients with each condition limited their study's ability to detect changes in health. They also noted that depression was "by far" the most prevalent of the four conditions examined and, significantly, it was the only one where improvements among Medicaid patients were found, suggesting that the sample pool affected results.
Second, Medicaid was shown to be valuable in other ways. Depression can affect the ability to get a job and be a responsible parent. Oregon's Medicaid patients saw their rates of depression drop by 30 percent. The Medicaid group was able to get more preventive health care than their uninsured counterparts, the value of which is well documented. And at its core, health insurance is protection that keeps people from facing financial ruin if they become sick or injured. Medicaid, the researchers found, operates the same way, relieving financial strain and worry for people who can least afford an unanticipated medical expense. Catastrophic expenditures for those with Medicaid were nearly eliminated.
Only people with good health insurance seem to make the argument that the poor are better off uninsured than in Medicaid. The best course for Florida remains accepting $51 billion in federal money over the next decade to provide health coverage for 1 million residents. The Oregon study is worth continuing, but the initial results do not alter that conclusion one bit.