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A Times Editorial

Medicaid pays big dividends

Results from a groundbreaking study prove what many health care advocates have assumed but some fiscal conservatives questioned: Being enrolled in Medicaid is better for the poor than being uninsured. Researchers with the respected National Bureau of Economic Research — a private, nonprofit and nonpartisan research firm — found that people who go from being uninsured to being insured under the state-federal program for low-income Americans are more likely to take care of their health and feel healthier, happier and more financially stable. For millions of uninsured Americans, the research suggests that the Medicaid expansion under the Affordable Care Act in 2014 cannot come soon enough.

It would seem obvious that when low-income people go from being uninsured to being covered under Medicaid that their access to medical treatment improves, as does their peace of mind. But some conservatives, including an expert with the American Enterprise Institute, have suggested that academic research points to the opposite conclusion: that doctors are so reluctant to take Medicaid patients due to the program's low reimbursement rates that uninsured people who pay cash, rely on emergency rooms or even charity care are better off.

These claims have muddied the conversation over the value of federal health care reform, which is expected to add about 16 million people to the Medicaid rolls starting in 2014. But now there is a clear finding that Medicaid provides a huge benefit in overall quality of life for a relatively small investment.

The study's conclusions are uniquely reliable due to the fact that researchers were able to take advantage of a quirk in Oregon's Medicaid program. In 2008, Oregon expanded its Medicaid rolls by 10,000 enrollees, but 90,000 people applied. Those who got to enroll were chosen randomly from the pool, giving researchers the rare opportunity to compare the lucky ones who were picked with thousands of those who weren't — a perfect control group.

The results: People with Medicaid were 35 percent more likely to go to a clinic or see a doctor. Women with insurance were 60 percent more likely to have mammograms. Individuals with insurance were 55 percent more likely to establish a relationship with a doctor. The insured also felt healthier. They were 25 percent more likely than the uninsured to say their health was good or excellent and 40 percent less likely to say their health had worsened.

The medical safety net had other positive consequences, including easing financial anxieties and bringing feelings of happiness. The insured were 25 percent less likely to have an unpaid bill sent to a collection agency and 40 percent less likely to have trouble with other bills due to medical expenses. They were 32 percent more likely than the uninsured to say they were happy to some extent — a tremendous boost.

All this good was accomplished for an estimated $800 more per year per enrollee in increased use of medical services. The enrollees, however, weren't the only beneficiaries. Society overall saved money on sick days, which were reduced by 15 percent. And stable, low-income families with an optimistic view on life will pay untold dividends long-term for the children in those families, as well as in their communities. Medicaid provides a terrific value. Now there's data to prove it.

Medicaid pays big dividends 07/08/11 [Last modified: Friday, July 8, 2011 7:18pm]

    

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