There has been much buzz lately about an article that was recently published in the New England Journal of Medicine on the impact of the "The Oregon Experiment — Effects of Medicaid on Clinical Outcomes" study. Okay, real quick, here is the gist of the study:
- In 2008 Oregon had enough funding to open up its Medicaid program to 10,000 people. But a whole lot more wanted in. What to do? Hold a lottery to determine who got in and who didn't.
- The seeds for a study were born. Sad situation but a great opportunity to assess the effectiveness of the program. Medicaid expansion in Oregon based on lottery drawings from a waiting list provided an opportunity to evaluate these effects.
- The study published in the New England Journal of Medicine showed that expanding Medicaid coverage to some low-income Oregon residents substantially improved their mental health and reduced financial strains on them, but it didn’t significantly boost their physical health.
And this is where opinion on what this means for Medicaid expansion diverges. Those against Medicaid expansion and the ACA in general seize on the lack of dramatic significance on changes in physical health.
- James Pethokoukis, a columnist for the conservative think tank American Enterprise Institute, called the study a “bombshell” in an article for Business Insider.
- New York Times economics reporter Annie Lowrey pointed out in a blog post that this latest paper is far from a comprehensive evaluation of the expansion as the study subjects had only been enrolled in Medicaid for two years at most.
However, it is important to step back a bit and look at the results of the study closely and hone in on some very significant positive findings:
- People on Medicaid ended up with significantly better mental health: The rate of depression among Medicaid beneficiaries was 30 percent lower than the rate of depression among people who remained uninsured. This is huge. Depression is the number one cause of loss of work worldwide. Better mental health leads to a wide range of positive impacts, not to mention fiscal impacts. If I feel better about myself I am more likely to contribute to my community, maintain employment, be a productive citizen and reduce the costs mental health challenges impose on a community.
- Medicaid significantly increased the probability of being diagnosed with diabetes (after the lottery) and use of diabetes medication. In addition, the study saw an increase in the use of preventive care. Both of these findings have significant long-term cost savings implications.
- Jonathan Cohn, in The New Republic, provides the following points worthy of consideration:
- The glass-half-empty version of that argument is that government will never get health care right, making the whole Medicaid exercise pointless. This is what many conservatives believe. But Medicaid clearly delivered other benefits for the enrolled Oregonians, starting with mental health. The presence of large improvements in mental health were just as surprising to the researchers as the lack of large improvements in physical health. Better mental health might be partly the result of a placebo effect, or the fact that people who don’t worry about medical bills have one less reason to be depressed. Whatever the reason, it's still "a big deal," as Adrianna McIntyre wrote at the blog Project Milennial. Not only might better mental health save some money, given the costs to society of lost productivity and activity. It should also save lives.
- The findings on financial security were just as significant. Medicaid effectively wiped out catastrophic medical expenses among the poor—and improved financial security in other ways. Obamacare critics have ignored or dismissed this finding, saying that financial security wasn’t a primary reason for health care reform. I suggest they go back and read the speech that Harry Truman gave in 1948, or the one Lyndon Johnson gave in 1965, or the one Bill Clinton gave in 1993, or the one President Obama gave in 2009. Financial security—specifically, the need to protect Americans from crushing medical bills—is the dominant theme in each of those speeches.
- And finally, “Medicaid virtually eliminated out-of-pocket catastrophic medical expenditures and reduced the probability of having to borrow money or skip paying other bills because of medical expenses by more than 50 percent,” the Oregon Health Study Group wrote on its website. “The big news is that Medicaid virtually wiped out crippling medical expenses among the poor: The percentage of people who faced catastrophic out-of-pocket medical expenditures (that is, greater than 30 percent of annual income) declined from 5.5 percent to about 1 percent. In addition, the people on Medicaid were about half as likely to experience other forms of financial strain—like borrowing money or delaying payments on other bills because of medical expenses."
- You can read the synopsis of the NEJ article - The Oregon Experiment — Effects of Medicaid on Clinical Outcomes - here.
- Visit the Oregon Health Study Group website for more information. The Oregon Health Insurance Experiment is a landmark, randomized study of the effect of expanding public health insurance on the health care use, health outcomes, financial strain, and well-being of low-income adults.
Okay Network faithful, read the articles and weigh in. It is important to look beyond the headlines and make informed decisions about Medicaid expansion. For those committed to improving mental health for children, youth and families, these preliminary results after two years of study are encouraging.
President & CEO
Children's Mental Health Network