This week, the New England Journal of Medicine published a major study of Medicaid in Oregon which has rapidly emerged of a Rorschach test of sorts. That is, partisans on either side of the political divide tend to see what they want to see in its results. While conservatives claim Medicaid expansion has been debunked by numbers showing little change in blood pressure, cholesterol, and diabetes over two years between those who did and did not gain access to Medicaid, liberals tout findings revealing "Medicaid improved rates of diagnosis of depression, increased the use of preventive services, and improved the financial outlook for enrollees."
Ultimately, as Ezra Klein, Kevin Drum, Aaron Carroll and Austin Frakt all conclude, the limited sample size, short-time frame and narrow measures of "health outcomes" make conclusions about the efficacy of Medicaid difficult to reach. But combined with other recent research, there is little question that Medicaid expansion will make the financial prospects and quality of life significantly better for the previously uninsured. As for the legion of Republican politicians instead insisting "no one goes without health care in America" because "you just go the emergency room," studies documenting the rapid disappearance of ER's and trauma centers show that GOP talking point is just a cruel joke.
Writing in the New York Times, Annie Lowrey provided a concise summary of what the NEJM paper says--and doesn't say--about the 10,000 out of 100,000 Oregonians who won the state's Medicaid lottery:
The Oregon Health Study released a new round of results on Wednesday, showing that Medicaid coverage does not seem to improve low-income adults' blood pressure, blood sugar or weight in a two-year time frame. It says nothing about the chance of diagnosis of, eventual health outcomes for or costs associated with any form of cancer, Alzheimer's, Parkinson's or dozens of other debilitating medical conditions. It also says nothing about health results outside of a two-year time frame...
Where it says something, it says a lot: it provides strong evidence that Medicaid recipients will spend more, use more tests, experience less depression, have fewer bills sent to collection agencies, and so on. It shows health insurance working just the way insurance is supposed to work: protecting the financial stability of the people purchasing it.
As it turns out, other recent analyses also had a lot to say about what happens when the uninsured gain coverage in ways similar to what will happen under the Affordable Care Act starting in 2014.