Medicaid Saves Lives, Though New Study Doesn’t Show It

My mother-in-law has just been released from the hospital, where she hastily checked in with what turned out to be a case of pneumonia and a related blood infection.

Serious for anyone, but especially someone like Mom, who’s approaching her 94th birthday.

I’ve been wondering whether she’d have gone to the hospital so fast if she hadn’t had Medicaid to supplement her Medicare benefits.

Would she instead have waited to see if the cough subsided and the breathing got easier, knowing she’d have to cover a deductible — and perhaps “coinsurance,” i.e., a copay — she couldn’t afford?

I doubt this would have crossed my mind if I hadn’t been reading responses to the recently-published study of the effects of expanded Medicaid coverage in Oregon.

As you may know, the researchers compared certain health-related measures for low-income Oregon residents who’d won and lost out in a lottery the state used to expand its Medicaid program.

No seniors like Mom in either group because Oregon, like all other states, provides some Medicaid coverage for all low-income Medicare beneficiaries who’ve also got quite limited savings and other financial assets.

So the researchers were comparing two groups of people between the ages of 19 and 65 — all quite poor, some insured by Medicaid and some with no health insurance.

Not surprisingly, they found that lottery winners used health services more, including for preventive care. Prescription medications as well.

They had virtually no catastrophic out-of-pocket expenses — also significantly less occasion to borrow money or skip paying other bills to pay those for their health care.

More surprisingly perhaps, they had significantly reduced rates of depression. (Any relationship here to relief from plaguing financial worries?)

On the other hand, the researchers found no significant effects on several basic health measures — diagnosis and treatment for high blood pressure and elevated cholesterol levels.

And though Medicaid apparently increased probabilities for diabetes diagnosis and medication, it had no significant effect on a measure used for diabetics’ blood sugar control — at least, not within the study timeframe.

This relatively small, highly technical study has proved a Rorschach test of people’s views of the Affordable Care Act, as a borrowed headline on The Incidental Economist says.

ACA opponents jumped on the findings, of course. The libertarian Cato Institute immediately saw “a huge ‘Stop’ sign” in front of Medicaid expansion.

Washington Post columnist Robert Samuelson found confirmation for his view that the ACA has been “oversold” as a measure to improve health — as indeed, has health insurance generally.

New York Times columnist Ross Douthat concluded that the study tended to support health insurance that covers only catastrophes because more comprehensive insurance doesn’t deliver better health, as ACA supporters said it would.

ACA proponents jumped on the findings too, arguing in part that protection from medical bankruptcy is a good enough reason to expand Medicaid, as the law initially required.

That, however, as they pointed out, isn’t the only benefit the study found. Many references to what one of the researchers called the “astounding finding” on improved mental health.

Some progressives also jumped on opponents for misunderstanding — or perhaps deliberately misusing — the health measure findings.

Kevin Drum at Mother Jones does a nice job here. As he explains, “significant” is used in its statistical sense, not as we commonly use it to signal something meaningful or important.

The study did find “fairly substantial improvements” for measures like high blood pressure, as Drum’s annotations of one of its tables shows. But the sample size was too small for these to meet the statistical test — a 95% confidence level.

Nearly lost in the back-and-forth on the latest paper are some findings from an earlier study by the same research team.

This one looked at several health measures, including what we might consider the most determinative — mortality rates.

Samples were large enough to get statistically significant results because the team was comparing rates in three states that had expanded their Medicaid programs with rates in three¬† that hadn’t.

Lo and behold, mortality rates went down in the expansion states — by 6.1%. That’s 2,840 fewer deaths a year for every 500,000 people who gained access to affordable health care through Medicaid.

Which brings me back to Mom, who might not be alive if she hadn’t gone to the hospital when she did.

And who probably wouldn’t be back in her own place now if Medicaid weren’t covering the costs of a home aide and a physical therapist to help her get more steady on her feet.

This isn’t statistically significant, but it’s pretty damn significant to me and others who love her.

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