Both A Cost And A Benefit
Whether adding people to Medicaid rolls improves health or just costs money was the subject of a recently published study, reports the New York Times (http://www.nytimes.com/2012/07/26/health/policy/medicaid-expansion-may-l...). Excerpts:
The study, published online Wednesday in The New England Journal of Medicine, comes as states are deciding whether to expand Medicaid by 2014 under the Affordable Care Act, the Obama administration’s health care law. The Supreme Court ruling on the law last month effectively gave states the option of accepting or rejecting an expansion of Medicaid that had been expected to add 17 million people to the program’s rolls.
Medicaid expansions are controversial, not just because they cost states money, but also because some critics, primarily conservatives, contend the program does not improve the health of recipients and may even be associated with worse health. Attempts to research that issue have encountered the vexing problem of how to compare people who sign up for Medicaid with those who are eligible but remain uninsured. People who choose to enroll may be sicker, or they may be healthier and simply be more motivated to see doctors.
The study, conducted by researchers from Harvard’s School of Public Health, analyzed data from three states that had expanded their programs in the last decade to cover a population not normally eligible for Medicaid: low-income adults without children or disabilities. The new law also expands coverage to a similar population nationally.
Researchers looked at mortality rates in those states — New York, Maine and Arizona — five years before and after the Medicaid expansions, and compared them with those in four neighboring states — Pennsylvania, Nevada, New Mexico and New Hampshire — that did not put such expansions in place.
The number of deaths for people age 20 to 64 — adults too young to be considered elderly by the researchers — decreased in the three states with expanded coverage by about 1,500 combined per year, after adjusting for population growth in those states. . .In the five years before the expansion, there were about 46,400 deaths per year, while in the five years after the expansion, there were about 44,900 deaths per year. During the same period, death rates in the four comparison states increased.
When researchers adjusted the data for economic factors like income and unemployment rates and population characteristics like age, sex and race, and then compared those numbers with neighboring states, they estimated that the Medicaid expansions were associated with a decline of 6.1 percent in deaths, or about 2,840 per year for every 500,000 adults added. . .the results support those of another Medicaid study being conducted by some of the same researchers in Oregon. Oregon expanded its Medicaid program in 2008, but, without money to cover everyone at first, chose 10,000 people by lottery. Dr. Baicker and her colleagues, comparing those who got Medicaid with those who did not, have so far found that Medicaid recipients see doctors more often, and report better health and better financial stability.
Janet M. Currie, director of the Center for Health and Well-Being at Princeton, said the new study, combined with the Oregon research, should help transform the Medicaid debate into one about dollars, rather than over whether covering poor people improves health.
“This says, well there is benefit to giving people insurance,” Dr. Currie said. “Maybe you don’t want to pay the cost, but you can’t say there’s no benefit.”
The study does not say there is 'benefit to giving people insurance'--it says there is benefit to giving people publicly financed health care. There is no benefit from having health insurance, with its 40% overhead (see yesterday's blog entry). There is a societal benefit from financing health care publicly with an overhead less than one-tenth as high as that found in private health insurance. And, arguably, if Americans were to reform health care financing and improve health care quality at the same time, we could spend no more on health care than we already tax ourselves for with universal and better care.
Dr. Joe Jarvis