Critics of expanding Medicaid under the Affordable Care Act are jumping on a new study released Thursday that undermines a chief argument for boosting the rolls of the government health insurance program for the poor.
The study, published in the journal Science, found that newly insured Medicaid recipients visited emergency departments significantly more than the uninsured. Some experts and supporters of Medicaid expansion expected just the opposite, that insuring more people would reduce costly ER visits as enrollees took advantage of more appropriate and affordable primary care services. With regular checkups and access to preventive care, new Medicaid recipients would head off urgent health crises and skip the ER for more routine problems in favor of their doctor’s office, the thinking went. That would make recipients healthier and also save Medicaid money.
But the new study suggests that signing people up for Medicaid leads them to use both more primary care and more emergency room treatment.
The study, which looked at 25,000 Medicaid participants in Oregon in 2008, found those who benefitted from expanded coverage increased their visits by a sizeable 40 percent over 18 months. The visits encompassed a range of health issues, including problems best treated by a primary care doctor. That’s precisely what policymakers want to avoid as they work to insure more people — expensive emergency visits that aren’t for, well, real emergencies.
The study is the third in a series of papers about Oregon’s Medicaid expansion. Researchers zeroed in on Oregon because it expanded Medicaid through a lottery system, allowing them to easily compare the effects of having health insurance using a randomized group.
It remains to be seen whether Oregon’s results will translate nationally.
Maine is one of 23 states resisting the Medicaid expansion. Gov. Paul LePage has refused to expand the program under the federal health reform law, though Democrats hope to overcome his opposition in the next legislative session.
Below is a smattering of reaction to the new study, both locally and nationally. First, the politicians, then the health policy wonks/experts. There’s plenty of buzz about the study today, so I tried to sample perspectives you may not have already stumbled across.
- Maine House Republican Leader Ken Fredette of Newport, in a Friday morning statement: “We must have an honest and fair debate about ObamaCare’s welfare expansion, and we cannot do that if Democrats continue to repeat things that we know are untrue in order to create political hype. Let’s look at the facts, which say that welfare expansion under ObamaCare is far more costly and far less beneficial than the president and Maine Democrats are making it out to be.”
- Maine Democrats focused their weekly radio address on the Medicaid expansion, but didn’t mention the new Oregon study specifically. Sen. John Patrick of Rumford: “Accepting this deal will save Maine $690 million over the next ten years, create more than 3,000 health care jobs, and inject $250 million into our economy…Every family should have a family doctor, and no one should have to fear that a medical emergency may lead to bankruptcy.”
- On Twitter, Brigham and Women’s surgeon and The New Yorker staff writer Atul Gawande (referencing all three papers): The Oregon study has now shown: Gaining health insurance increases well being, solvency, use of primary care, specialists, ER. Health insurance doesn’t improve mortality immediately. If it does, it takes time. Insurance provides huge value. It’s a good buy for society. But it doesn’t magically pay for itself. That myth must be retired.
- Harold Pollack, professor at the University of Chicago appointed to two Institute of Medicine committees (and the guy behind the 4×6 index card with “all the financial advice you’ll ever need”): Although the dollars at stake are small, this finding will probably generate much partisan sniping related to health reform. Liberals will be disappointed. Conservatives will be correspondingly pleased. Neither side will confront the realities of emergency care which go beyond the usual talking points.
- From two authors on the much-read Incidental Economist blog, maintained by researchers and professors in health economics, law, or health services: The latest results from Oregon aren’t actually very counterintuitive and “overuse” of the emergency department isn’t “consumers making ‘bad’ choices, but the system offering poor ones.”
- Art Kellermann, dean of the Hebert School of Medicine at the Uniformed Services University of the Health Sciences (the U.S. military’s medical school), via Twitter: Wonder why M’caid patients in Oregon are going to the ER? Colleagues and I answered that question 20 years ago (in a 1994 study that found Medicaid recipients in urban areas have limited access to outpatient care outside of that provided by hospital ERs).