NEJM Study Finds Mixed Results on Benefits of Medicaid Coverage

Although having insurance through Medicaid lowers a person's risk of depression and catastrophic medical expenses, it does not necessarily result in substantial improvements to physical health, according to a study published Thursday in the New England Journal of Medicine, the Los Angeles Times' "Politics Now" reports (Levey, "Politics Now," Los Angeles Times, 5/1).

The study aims to examine the effect of Oregon's decision to open its Medicaid program to low-income adults in 2008 through a lottery system. Overall, 89,824 state residents entered the lottery to gain access to Medicaid (California Healthline, 6/25/12).

Study Details

For the study, dubbed the Oregon Health Study, researchers at the Harvard School of Public Health and Massachusetts Institute of Technology compared health care use and outcomes of low-income Oregon residents -- who were accepted into the state's Medicaid program -- with an identical group of residents who remained uninsured (Lowrey, New York Times, 5/1).

About two years after the lottery was conducted in 2008, researchers obtained data from 6,387 adults who were randomly selected to be able to apply for Medicaid coverage and 5,842 adults who were not selected. The data covered blood pressure, cholesterol and blood sugar levels, as well as screenings for depression, medication use and out-of-pocket spending for various services (Baicker et al., NEJM, 5/2).

Researchers found that Medicaid beneficiaries were 30% less likely to have depression, compared with uninsured individuals. Beneficiaries also virtually eliminated the risk of catastrophic medical expenses from a serious accident or the sudden onset of a life-threatening illness, AP/U-T San Diego reports (Alonso-Zaldivar, AP/U-T San Diego, 5/1).

In addition, beneficiaries were nearly 10% more likely to report that their health status was the same or improved over the previous year, compared with uninsured individuals ("Politics Now," Los Angeles Times, 5/1). Beneficiaries also typically had higher use of preventive health care services, such as mammograms and cholesterol tests, raising their health care spending by at least 35% compared with those who remained uninsured.

The study's researchers noted that health care use did not spike or fluctuate in the insured group throughout the study period, dispelling some experts' theories that newly enrolled beneficiaries would be more compelled to see a physician and have their ailments assessed and then cease receiving care, the New York Times reports (New York Times, 5/1).

Meanwhile, the researchers found that while Medicaid beneficiaries had better access to care and were more likely to receive diagnoses and treatment for diabetes, they did not experience significant improvements in blood-pressure, cholesterol or blood sugar levels (AP/U-T San Diego, 5/1).

According to "Politics Now," the study's findings could provide states with further insight into Medicaid and help them in deciding whether to expand the program under the Affordable Care Act. More than a dozen states, many of them led by Republican governors, have rejected the expansion. Some have argued that Medicaid is ineffective, while several other conservative critics have said the program is just as bad as having no insurance coverage.

Lead Study Author, Administration Officials, Observers Comment on Findings

Lead study author Katherine Baicker, a professor at Harvard University, said the study "dispels two extreme arguments" about Medicaid:

• The program is "a waste of resources," which she said "is clearly not the case;" and
• The "opposing view that this is a wonderful program that keeps people out of the hospital and that it provides all this preventive care that saves money" ("Politics Now," Los Angeles Times, 5/1).

According to AP/U-T San Diego, Obama administration officials -- in a reaction accompanying the study -- suggested that the two-year analysis period might be insufficient to determine the benefits of Medicaid, particularly the physical health results for patients with chronic conditions who might be influenced by lifestyle choices. The officials also noted that only about 12,000 individuals were involved in the analysis, which is relatively small compared with the millions who would gain coverage under the ACA (AP/U-T San Diego, 5/1).

Zeke Emanuel -- a former health policy adviser to President Obama -- called the latest findings "disappointing" because they show that "there are benefits to providing Medicaid but that we also need to fix the system."

Meanwhile, some ACA opponents said states could use the results as a reason to reject the Medicaid expansion. Michael Cannon, the Cato Institutes' health policy director, said, "This throws up a huge stop in front of" the expansion (Kliff, "Wonkblog," Washington Post, 5/1).

John Goodman, president and CEO of the National Center for Policy Analysis, said the findings suggest "to me that Medicaid doesn't matter very much," adding, "A lot of people are way too focused on health insurance and not focused enough on health care" ("Politics Now," Los Angeles Times, 5/1).