What Does the Oregon Medicaid Report Tell Us About Health Insurance?

Submitted by jonpearce on Sat, 2013-03-02 20:50

Few recent issues have generated as much contradictory interpretation from the same set of facts at the recent release in the New England Journal of Medicine (link is here, but requires subscription) of its analysis of the Oregon Medicaid program. The articles cited below give far more detailed descriptions of this report, but basically it concluded in a randomized study that people covered by that Medicaid program had no measureable difference in several major health status metrics (other than for depression) than others who had no health insurance.

First came the Forbes article (“Oregon Study: Medicaid 'Had No Significant Effect' On Health Outcomes vs. Being Uninsured”) that presents a detailed analysis of the methodology used by the study, and indicate several biases or other shortcomings that may limit its inclusiveness. This author concludes, however, that the study shows that Medicaid is largely ineffective in improving the health status of its members.

The next article that I read ("Study: Giving People Government Health Insurance May Not Make them Any Healthier”) by Megan McArdle of The Daily Beast goes even further in her criticism of Medicaid, and extends her argument to the fact that approximately 1/2 of the currently uninsured population will receive health insurance through Medicaid as a result of the ACA, and that this care may be as ineffective as that provided by Oregon Medicaid.

A completely different conclusion was reached by Dr. John Lumpkin in the Health Affairs blog "Oregon’s Medicaid Experiment: Coverage Is The First Step”. Dr. Lumpkin focuses on the fact that individuals covered by Medicaid utilized services at a much higher level than the uninsured, and experienced fewer financial difficulties caused by lack of coverage. He minimized the importance of the lack of documented clinical effectiveness of health insurance coverage, noting that "at least they are now participating in the health care system and getting the care that they need…".

Finally, healthcare economist John Goodman wrote "You Can Lead a Horse to Water…”, in which he notes that of those who applied for the lottery for Oregon Medicaid and were granted access to the program, only 30% actually signed up. He extrapolates this result to suggest that many of the uninsured are intentionally in that status, and would not participate in a health insurance program even if it was free (as Medicaid is).

We're not going to support or oppose any of the opinions of these authors, but prepared this list as an example of the fascinating contrasts that can be drawn from the same set of facts. Hopefully some of the Singletrack blog readers will enjoy the interesting diversity of opinions in these articles. Supposedly the truth is out there (although maybe only in the X Files) but you'd never know it from today's healthcare news.