How the Liberal Press is Spinning the Oregon Medicaid Study


As Peter Suderman reported yesterday, The New England Journal of Medicine released a study on Oregon's Medicaid program — and it has sent liberal supporters of ObamaCare into a tailspin. The study is significant because its sample size is both random and large and therefore its findings are a decent first, though not conclusive, indication of what Medicaid will — or, rather, won't — accomplish if ObamaCare succeeds in pumping gazillions of dollars more into the program to achieve its goal of universal coverage. Bear in mind that the main point of offering coverage to America's 40 to 50 million uninsured is to improve health and save lives.

The study compares the health outcomes of more than 12,000 able-bodied uninsured adults below 100 percent of the poverty line, about half of whom were randomly enrolled in Medicaid and about half of whom were not. This kind of random assignment is as close to a lab-style controlled experiment as one can conduct in real life because it controls for variables such as race, income and health status, isolating the impact of the program.

Here's how it summarized its own core findings:

Approximately 2 years after the lottery, we obtained data from 6387 adults who were randomly selected to be able to apply for Medicaid coverage and 5842 adults who were not selected. Measures included blood-pressure, cholesterol, and glycated hemoglobin levels; screening for depression; medication inventories; and self-reported diagnoses, health status, health care utilization, and out-of-pocket spending for such services.

We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels [a marker for diabetes] or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression (?9.15 percentage points; 95% confidence interval, ?16.70 to ?1.60; P=0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures.

This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.

(Emphasis added.)

And how are liberal pundits reporting its findings? Take a look at a not-so-random sampling of their headlines and excerpts.

 The New Republic's Jonathan Cohn:

 The New Study that Republicans Who Reject Medicaid Must Read

A report indicates just how important it can be in improving poor people's lives

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…

The other big finding was that people on Medicaid ended up with significantly better mental health: The rate of depression among Medicaid beneficiaries was 30 percent lower than the rate of depression among people who remained uninsured. That's not just good health policy. That's good fiscal policy, given the enormous costs that mental health problems impose on society—by reducing productivity, increasing the incidence of violence and self-destructive behavior, and so on…

But one place improvement did not appear was physical health. And this was something of a surprise…

Mother Jones, Kevin Drum

Followup: Medicaid Probably Does Improve Health Outcomes After All

In fact, the study showed fairly substantial improvements in the percentage of patients with depression, high blood pressure, high cholesterol, and high glycated hemoglobin levels (a marker of diabetes). The problem is that the sample size of the study was fairly small, so the results weren't statistically significant at the 95 percent level.

However, that is far, far different from saying that Medicaid coverage had no effect. It's true that we can't say with high confidence that it had an effect, but the most likely result is that it did indeed have an effect…

Bottom line: Access to Medicaid probably did improve health outcomes. It's just that the study was too small to say that with certainty.

(Emphasis original.)

The Washington Post, Sarah Kliff

Study: Medicaid reduces financial hardship, doesn't quickly improve physical health

As heated fights over the health law's Medicaid expansion engulf state legislatures, a sweeping new study indicates that the program is unlikely to quickly improve enrollees' physical health.

The research, published Wednesday in the New England Journal of Medicine, did find that low-income people who recently gained Medicaid coverage in Oregon used more health-care services.

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.

The Incidental Economist, Aaron Carroll and Austin Frakt 

Oregon and Medicaid and Evidence and CHILL, PEOPLE!

First of all, we're somewhat annoyed that the NEJM sent out press releases and the study to journalists, but not people like us, because we now have to rebut the gazillion stories that have already been written on a study I just found out about an hour ago. Maybe they should let some knowledgeable people see it early, too. Or just wait until it goes live to tell everyone. But we digress. Let's get into it.

Early results showed some promising evidence that Medicaid improved process measures, self-reported health, and enhanced financial protection. This update, at 2 years, was intended to give us some harder outcomes. The results are "mixed"…

 The New York Times, Annie Lowrey

Medicaid Access Increases Use of Care, Study Finds

It found that those who gained Medicaid coverage spent more on health care, making more visits to doctors and trips to the hospital. But the study suggests that Medicaid coverage did not make those adults much healthier, at least within the two-year time frame of the research, judging by their blood pressure, blood sugar and other measures. It did, however, substantially reduce the incidence of depression, and it made them vastly more financially secure.

Readers are invited to read the original articles and give their own Pinocchio rating with "zero" indicating most honest and "five" most dishonest.

One thing to note, this study is consistent with scores of others as Avik Roy notes here showing that Medicaid produces no appreciable physical health gains for its beneficiaries compared to those without insurance.

Update: Ezra Klein's old post was erroneously included in the sample.

Update II: I'll keep updating new headlines and stories about the study as they keep filtering in. Here's one now:

Associated Press, Ricardo Alonso-Zaldivar 

Medicaid Improved Mental Health for Uninsured

If you're uninsured, getting on Medicaid clearly improves your mental health, but it doesn't seem to make much difference in physical conditions such as high blood pressure.

The counterintuitive findings by researchers at Harvard and MIT, from an experiment involving low-income, able-bodied Oregonians, appear in Thursday's New England Journal of Medicine. The study offers a twist for states weighing a major Medicaid expansion under President Barack Obama's health care law, to serve a similar population of adults around the country…

It also debunks a widespread perception that having Medicaid is no better, and maybe even worse, than being uninsured.