Will Obamacare Make America Healthy?

Medical Director Elisa Melendez examines Maximo Chavez, during his two week checkup at Clinica Tepeyac in Denver, CO, Thursday, March 22, 2012. His mother, Lilian Mendoza, says her family does not have insurance but hopes Maximo will qualify for Medicaid

A newly released study examined Medicaid effectiveness in Oregon, a topic of particular interest given that Obamacare greatly increases Medicaid coverage. Sarah Kliff summarizes the mixed results:

New Medicaid enrollees had less trouble paying their bills and saw significant improvements in mental health outcomes, with rates of depression falling by 30 percent. But on a simple set of health measures, including cholesterol and blood pressure levels, the new Medicaid enrollees looked no different than a separate group, who applied for the benefit but were not selected in a lottery.

Suderman pounces:

This study is perhaps the best and most important study of Medicaid’s health effects ever conducted, and it has huge implications for public policy—in particular for Obamacare’s Medicaid expansion, which is supposed to account for about half of the law’s increase in health coverage. Obamacare supporters had used the results from the study’s first year, which showed large gains in self-reported health, to argue that the law’s expansion of Medicaid was justified. The second-year results significantly complicate that argument.

Michael Cannon piles on:

There is no way to spin these results as anything but a rebuke to those who are pushing states to expand Medicaid. The Obama administration has been trying to convince states to throw more than a trillion additional taxpayer dollars at Medicaid by participating in the expansion, when the best-designed research available cannot find any evidence that it improves the physical health of enrollees. The OHIE even studied the most vulnerable part of the Medicaid-expansion population – those below 100 percent of the federal poverty level – yet still found no improvements in physical health.

Jonathan Cohn sees the study differently:

The big news is that Medicaid virtually wiped out crippling medical expenses among the poor: The percentage of people who faced catastrophic out-of-pocket medical expenditures (that is, greater than 30 percent of annual income) declined from 5.5 percent to about 1 percent. In addition, the people on Medicaid were about half as likely to experience other forms of financial strain—like borrowing money or delaying payments on other bills because of medical expenses.

That may sound obvious—of course people with insurance are less likely to struggle with medical bills. But it’s also the most under-appreciated accomplishment of health insurance: Whatever its effects on health, it promotes economic security. “The primary purpose of health insurance is to protect you financially in event of a catastrophic medical shock,” Finkelstein told me in an interview, “in the same way that the primary purpose of auto insurance or fire insurance is to provide you money in case you’ve lost something of value.”

Aaron Carroll is on the same page:

The reason I have insurance, and likely you do as well, is to protect you from financial ruin. When I get sick, I don’t sit at home and let the insurance take care of me. I get off my butt and use the health insurance as the means by which to get health care. Medicaid is about access. It’s just the first step in the chain of events that leads to quality.

Avik Roy counters this argument:

[W]e could have achieved the same outcome for a fraction of the price, by adopting the plan proposed by Florida’s Will Weatherford and Richard Corcoran: Offering low-income Americans a subsidy with which to purchase catastrophic coverage on the open market. That plan was foiled by people—including Republicans—who insisted on expanding Medicaid instead.

McArdle lowers her expectations:

Given this result, what is the likelihood that Obamacare will have a positive impact on the average health of Americans? Every one of us, for or against, should be revising that probability downwards. I’m not saying that you have to revise it to zero; I certainly haven’t. But however high it was yesterday, it should be somewhat lower today.

And Ray Fisman feels that “the findings should give pause to even those who are most committed to universal health insurance.” The lesson he draws:

[T]he Oregon experiment is yet another argument in favor of the increasingly common view that access to medical care is necessary but far from sufficient for good health. What’s the use in prescribing statins to reduce cholesterol to patients who don’t take their meds, continue to consume potato chips and soda unabated, and ignore health care providers’ pleas to walk more and drive less?

But changing habits, compliance, and lifestyles is a much taller order, and viewing health care in this way can make the Affordable Care Act, despite its enormous ambitions, seem almost too timid or narrow in its focus. It requires that our conception of health care go beyond a passive delivery system of waiting for patients to come into the clinic and get out into the community to reach patients in their daily lives.

(Photo: Medical Director Elisa Melendez examines Maximo Chavez, during his two week checkup at Clinica Tepeyac in Denver, CO, Thursday, March 22, 2012. His mother, Lilian Mendoza, says her family does not have insurance but hopes Maximo will qualify for Medicaid in the near future. Craig F. Walker, The Denver Post via Getty Images)