Health insurance matters

Updated
 

By now, you’ve probably heard about the Oregon study from last week that conservatives are all excited about. The research concludes that Medicaid coverage meant improved early detection and management of ailments such as diabetes, lower rates of depression, and reduce financial strain, but “generated no significant improvements in measured physical health outcomes” in the first two years of coverage.

The conservatives you’d expect to tout the findings have done so, suggesting there’s now “proof” that Medicaid coverage has “no effect” on the health of beneficiaries. That’s really not what the report said, but with remarkable speed, it became a widely accepted truth on the right.

Kevin Drum has been all over this – with 1, 2, 3, and 4 posts – and instead of reinventing the wheel, I’ll just say his coverage is well worth your time. The same is true of the analyses from Aaron Carroll, Austin Frakt, and Harold Pollack. In fact, I wish Ross Douthat had read their scrutiny before publishing this column this morning.

The state of Oregon expanded its Medicaid program via lottery a few years ago, and researchers released the latest data on how health outcomes for the new Medicaid users differed from those for the uninsured. The answer: They didn’t differ much. Being on Medicaid helped people avoid huge medical bills, and it reduced depression rates. But the program’s insurance guarantee seemed to have little or no impact on common medical conditions like hypertension and diabetes.

That’s wrong. In fact, given the available scrutiny of the Oregon study, it’s wrong enough to warrant an NYT correction.

Douthat added:

[I]t’s also true that the health care law was sold, in part, with the promise (made by judicious wonks as well as overreaching politicians) that it would save tens of thousands of American lives each year. There was so much moral fervor on the issue, so much crusading liberal zeal, precisely because this was not supposed to be just a big redistribution program: it was supposed to be a matter of life and death.

But if it turns out that health insurance is useful mostly because it averts financial catastrophe – which seems to be the consensus liberal position since the Oregon data came out – then the new health care law looks vulnerable….

If the first claim is simply wrong as a matter of factual detail, this second claim is wrong as a matter of flawed judgment.

Indeed, Brian Beutler makes the case that Douthat has his head in the sand.

First: financial security for millions of people is a huge deal on its own and ACA’s critics need to contend with the fact that repealing the law will impoverish hundreds of thousands relative to a scenario in which the law is fully implemented. But also, it’s completely possible that though the most common benefit of health insurance is economic, it has the ancillary benefit of preventing some deaths. Those are both very strong reasons to support extending Medicaid coverage to millions more people, just as the ACA envisions.

But I would not say that the Medicaid study disproves ACA supporters who point out insurance is a matter of life and death. Here’s how Frakt put it to me in an email: “It’s absolutely the case that the most recent study from the Oregon Health Insurance Experiment is uninformative about physical health due to low sample. Consequently, it is also uninformative about mortality…. [W]hatever one’s prior position was on the direct insurance-mortality link, it shouldn’t change one iota based on this study. Indirectly, the study should actually increase your view that there is such a link to the extent you think access to mental and physical health care ever saves lives. We all believe that at least a little, right?”

Medicaid and Oregon

Health insurance matters

Updated