Although expanding Medicaid coverage to some low-income Oregon residents substantially improved their mental health and reduced financial strains on them, it didn鈥檛 significantly boost their physical health, in the New England Journal of Medicine.
Image by Darwinek via Wikimedia Commons
The findings are聽less聽upbeat聽than a preliminary report , which had found聽that Medicaid made a 鈥渂ig difference鈥� in people鈥檚 lives. In the latest effort, researchers聽dug deeper. They聽compared health status, finances and use of health services between two groups of residents: some of the 10,000 people who had been selected through a lottery drawing for health insurance coverage under a 2008 limited expansion to Oregon鈥檚 Medicaid program and those who had applied but did not get accepted.
Based on analyses of 12,229 people 鈥� 6,387 of whom gained coverage 鈥� the study鈥檚 results did not show any significant difference in the levels of high blood pressure, high cholesterol and diabetes between the two groups two years after the lottery.
The study did find improvements in other categories, including mental health. Gaining access to Medicaid, for example, reduced depression by 30 percent and also increased participants鈥� use of physician services, prescription drugs and preventive care. It also led to increased detection of diabetes and use of medication to control it.
Those covered by Medicaid also had lower out-of-pocket spending, the researchers reported, including a 4.5 percentage point difference in catastrophic expenditures.
鈥淲e were able to provide a multifaceted picture of what happened when people gained insurance through Medicaid, versus those who did not,鈥� said , the study鈥檚 lead author, in an interview.
, senior fellow at the , a nonpartisan research organization, said he was shocked to see so little data suggesting that Medicaid expansion improved overall health.
鈥淚t didn鈥檛 seem to affect the outcome of those with diabetes,鈥� Herrick said in an interview. 鈥淚t boosted their use of medication but didn鈥檛 seem to improve their health 鈥� that鈥檚 something we would all assume.鈥�
鈥淭he results of this indicate that states can鈥檛 just expand Medicaid and as a result, suddenly improve the health of all those that enroll 鈥� it didn鈥檛 seem to work that way,鈥� Herrick added.
According to the study, more than 90,000 state residents participated in Oregon鈥檚 Medicaid lottery. Researchers have used that group to study the impact of expanding health coverage. Although not designed to do this, Baicker said the two groups can be seen much like a randomized controlled trial that allows researchers to evaluate the effect of Medicaid on low-income adults.
鈥淓xpanding Medicaid costs money and there has to be a way to finance the program. It doesn鈥檛 save money but it substantially improves the wellbeing of beneficiaries, although maybe not in exactly the way some people might have thought,鈥� Baicker said, adding that 鈥減olicymakers have to decide whether that set of benefits is worth the cost of the program in terms of the alternative uses of the resources.鈥�
The expansion of Medicaid, called for by the 2010 health care law, is聽being intensely聽debated in many states since the Supreme Court made that provision voluntary last year. Fifteen states, many in the Republican-controlled South, have already rejected the idea, while 20 have agreed to comply with the law, according to .