Using findings from a recent study about Medicaid in Oregon as a basis for not accepting federal funds in New Hampshire is misguided at best.
In 2008, Oregon expanded Medicaid coverage to adults based on a lottery drawing from a waiting list of uninsured people. The study evaluated the impact of Medicaid on health care utilization, out-of-pocket health care spending, and on four health conditions (blood pressure, cholesterol, diabetes and depression).
The study, released this month, found that Medicaid coverage decreased depression rates but did not lead to statistically-significant changes in the other three health conditions. The study also found that people with Medicaid went to the doctor more and received more tests. Last but not least, Medicaid eased financial strain by reducing out-of-pocket health care spending, catastrophic expenditures and medical debt.
Some have characterized this study as proof that Medicaid does not improve health and therefore is of no value.
A few points need to be made, however.
- A substantial reduction in depression rates is a very positive health outcome. Depression is a costly condition. To a state struggling to fund its mental health system adequately, an insurance program that shows significant reductions in depression rates, treatment that’s largely paid for by the federal government, would be a significant benefit.
- Medicaid is health insurance and health insurance is meant to protect you financially if you get sick. Medicaid did that for people in Oregon. Money that doesn’t go to cover catastrophic health bills is money that pays for food, housing, and other basic needs for a family.
- Previously uninsured people, who finally get coverage, are going to access health care and therefor may have increased costs if health care reimbursement is fee-for-service and not outcome based. These potentially higher costs point once again to the need for payment reform that ties reimbursement to improved outcomes as opposed to the number of tests or office visits.
- Changes that are not statistically significant are not the same as failure. For example, Medicaid lowered the percentage of people with elevated blood pressure from 16.3 percent to 15 percent. The percentage of people with diabetes with markers for poor control of blood glucose levels went down from 5.1 percent to 4.2 percent, and the share of people with high total cholesterol went down from 14.1 percent to 11.7 percent. Given there were relatively few people in the study with these conditions, however, researchers were unable to draw firm conclusions.
The Oregon study clearly shows that Medicaid has real value for the people who receive it. Consequently, accepting federal funds to extend Medicaid to more low-income adults would have substantial benefits for them and for the state as a whole. New Hampshire lawmakers have no good reason to wait.