The bombshell Oregon Medicaid study released this week should give all states pause as they consider plans to expand Medicaid under the Affordable Care Act. The study, the first randomized-controlled test of the system, showed that there were little positive health outcomes in the two years since Oregon expanded Medicaid coverage to thousands of individuals.
The many attempts to spin the results as not as bad as they seem, or even to call them positive, are shameful at best. The high points of the study-increased use of health services and statistically significant improved mental health-give supporters of Medicaid expansion little to rally behind.
Increased use of health services does not prove much, if anything. It may actually suggest that the services would suffer under greater use. The shrinking number of providers who accept Medicaid are facing a growing number of people eligible for the program. The history of Medicaid shows that even at its creation, the quality of the care received was not a focus.
As for the rate of depression-Megan McArdle of The Daily Beast considers the possibility that just having Medicaid could improve the mental health outlook of recipients, as there was no corresponding significant increase in the use of anti-depressants.
Taken together, these “positive” outcomes from the study prove the most basic problem with Medicaid. The program has become no more than a security blanket. If the mere sense of security is truly the only benefit of Medicaid, (as might be said for varied types of insurance), then there are far better ways that states can provide this security than expanding the ever-cost-increasing federal program to more of its citizens.
Instead of playing games with the facts, state and federal officials should start to look at how the system can be improved. States in particular must ask what the point of Medicaid is in the first place. The difference between “health insurance” and “health care” has never been clearer.
If states want to provide insurance to low income residents to protect them in case of a catastrophic medical event, Medicaid is far too much coverage. If states want to ensure that families below or near the poverty line have mere “access” to care, Medicaid is the expensive answer. But if states want to provide high-quality health care to that same population, the Oregon study shows that Medicaid is a costly, ineffective way to do that, and an alternative must be found.
There are still 16 states that have yet to decide on Medicaid expansion. Straining financial resources of government to further dilute the quality of care cannot possibly be the best way to make sure more state residents live healthy lives.
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