Does Medicaid Really Provide Better Clinical Outcomes?
The expansion of Medicaid provided by the Affordable Care Act (ACA) began in 2014. Reports are now coming out on the clinical impact of Medicaid on newly-insured patients. Headline and sound-bite pronouncements lead a person to believe the Medicaid expansion has made a tremendous difference.
The most recent report looked at three states - Kentucky and Arkansas that expanded Medicaid and Texas that did not. Comparing the two states that expanded Medicaid with Texas, the authors found a 41 percent increase in patients reporting a “usual source of care” and a 23 percent increase in “self-reported excellent” health. The researchers also found that the newly-insured had a $337 per year out-of-pocket savings on health care expenditures.
While these results seem to confirm the value of the Medicaid expansion, they need to be taken in context. Theoretically, those patients newly-placed on Medicaid now have health insurance and the “usual source of care” should approach 100 percent. Forty one percent is not even half and either reflects the difficulty Medicaid patient have in finding a provider who can afford to see them or suggests that even with health insurance people don’t go to the doctor.
Any “self-reporting” is not scientific and does not measure objective outcomes. Consequently, “self-reported excellent” health does not equate to clinical excellent health.
A certain amount of out-of-pocket savings is expected. Medicaid is an entitlement and health care is essentially free to enrollees. The fact that new Medicaid enrollees save $337 per year is not a surprise.
Researchers who published a second recent study concluded that the ACA increased the early detection of five types of cancer by around one percent. The study was a comparison of reported early cancer detections in 2013 with early cancer detections in 2014, the first year of benefits of Obamacare. The authors admit the percent change is small.
It should be noted that the cancer study did not control for any other possible explanations. For example, did the American Cancer Society or some other organization have a campaign in 2014 that alerted more providers and patients to get early cancer screening?
At best, these studies show a very slight change in health care outcomes for Medicaid patients. The reports, however, do not address the $545 billion spent on Medicaid last year and the projected cost of $700 billion by 2020. (here) Likewise, multiple studies that were scientifically controlled have shown no improvement in clinical outcomes for patients in the Medicaid entitlement. (here)
The country needs meaningful health care reform that does not trap low-income people in a poor insurance plan like Medicaid.