Perspectives on the Oregon Medicaid experiment
Tuesday, May 14, 2013
Does Medicaid coverage make people healthier? New data drives
When Oregon found it had enough money to provide Medicaid to an additional 10,000 low
income residents out of as many as 90,000 who might have qualified, the state established a lottery to distribute the new coverage randomly. As a result, a NewYork Times story by Annie Lowrey explains, economists and social scientists had a once-in-a-life time chance for a randomized controlled experiment on Medicaid's impact, examining the newly covered in comparison to a group of 10,000 low income people who lost in the lottery.
In the two-year study, reported in The NewEngland Journal of Medicine, researchers found the new coverage did not significantly affect hypertension or high cholesterol, or the use of drugs to treat those conditions. Those covered visited doctors more, spent less on medical care and were less financially insecure. The strongest impact seemed to be on depression. Among new recipients the probability of depression was reduced by 30%, compared with the group without Medicaid.
Katherine Baicker, a health economist at the Harvard School of Public Health and a lead researcher, said those covered believed their health was better and statistics for that group did show increased diagnosis and treatment of diabetes and hypertension.
An NPR story by Julie Rovner reports some results and discusses costs. She quotes Scott
Gottlieb, a Medicaid critic, physician and fellow at the conservative AmericanEnterprise Institute, who questions whether Medicaid should be expanded without addressing existing program flaws. Another physician, JohnLumpkin, who writes the healthaffairs.org blog thinks the Oregon study suggests coverage is first step toward better health. MatthewYglesias, on Slate, asserts the study findings are too limited to prove anything we didn't already know. He says they shouldn't change any opinions.
In the Washington Post Jordan Rau interviews a 55-year-old low-income woman who won the Oregon lottery. Her statistics wouldn't document improvement, she notes, but her hypertension medication is greatly reduced, she's lost weight, and her blood sugar is more consistently managed. She also describes an emotional side of being able to care for her own health: "There is just something about feeling like you're part of regular life.”