Right-wing media have seized on a study of Medicaid recipients to attack the program by focusing on certain parts of the findings while health care experts point out that the program successfully expanded access to care and eased health-related financial problems, the primary focus of Medicaid.
In 2008, the state of Oregon held a lottery to expand Medicaid coverage to 10,000 people. Because the selection was random, researchers began a controlled study on how the coverage affected the participants. After the results were posted in The New England Journal of Medicine, right-wing media seized on the findings to attack both Medicaid and health care reform. On May 2, Fox Nation posted a Washington Examiner article on the study under the headline "Landmark Study Shatters Liberal Health Care Claims." In the article, Examiner senior editorial writer Philip Klein noted that the study's authors found that enrollment in Medicaid led to "lower rates of depression," but Klein wrote that "the study suggests that expanding Medicaid ... does not improve" the health of recipients. On Your World, Fox's senior managing editor for health news, Dr. Manny Alvarez, used the findings to attack the Affordable Care Act (ACA):
On May 3, Fox & Friends co-host Steve Doocy called the Medicaid study "[b]ad news for Democrats who support Obamacare." On-screen text during the segment stated that the study found that Medicaid is "ineffective":
But while Fox used the study as an opportunity to attack various aspects of health care reform, experts have pointed out that the study's findings, while not entirely positive, show that the program aided the new enrollees in several ways. In a Health Affairs blog post, Dr. John Lumpkin, who served for 12 years as the director of the Illinois Department of Public Health, wrote that the study showed that "coverage alone will not necessarily lead to good health," but also pointed to the "big impact on family finances" and the fact that "expanding Medicaid was shown to substantially reduce depression." Dr. Lumpkin concluded:
So far, the Oregon Health Insurance Study shows us that people who obtained Medicaid coverage received more health care services in the first two years--especially needed preventive care--and had less depression and financial worries. Their health outcomes weren't significantly better, but at least they are now participating in the health care system and getting the care they need, without plunging their families deeper into poverty. From this vantage point, the glass seems more than half full.
Health policy expert Aaron Carroll and health economist Austin Frakt pointed out that the study "shows that some things improved for people who got Medicaid. For others, changes weren't statistically significant, which isn't the same thing as certainty of no effect." Frakt and Carrol also noted that "it didn't show that Medicaid harms people, or that the ACA is a failure, or that anything supporters of Medicaid have said is a lie." The post summarized the findings by saying:
Let's review. The good: Medicaid improved rates of diagnosis of depression, increased the use of preventive services, and improved the financial outlook for enrollees. The bad: It did not significantly affect the A1C levels of people with diabetes or levels of hypertension or cholesterol.
This has led many to declare (and we're not linking to them) that the ACA is now a failed promise, that Medicaid is bad, and that anyone who disagrees is a "Medicaid denier". How many people saying that are ready to give up insurance for themselves or their family? If they are arguing that Medicaid needs to be reformed in some way, we're open to that. If they're arguing that insurance coverage shouldn't be accessible to poor Americans in any form, we don't agree. Medicaid may not be perfect, but we don't think being uninsured is better. This new study supports this view, though certainly not as strongly as it might have.
In the Washington Post's Wonkblog, Ezra Klein wrote that the study demonstrated that Medicaid worked effectively as a health insurance program because it achieved the goal of expanding access to health care:
Here's what we can say with certainty: Medicaid works as health insurance.
That might seem obvious. It's actually not. A big criticism of Medicaid is that it pays doctors so little that it's essentially worthless because no doctor will see you. But the Oregon residents who won the Medicaid lottery got much more health care -- including preventive health care -- than the residents who lost it. They also saw catastrophic health costs basically vanish.
So here's what happened in the first two years of the Oregon Medicaid experiment: Medicaid proved itself good health insurance. The people who got Medicaid used more health care, and seem to have done so smartly -- they got preventive care, they got their diabetes diagnosed and began managing it, treated their depression, and so on. But the health care itself didn't work as well as we hoped -- at least not in terms of cutting rates of hypertension and cholesterol.