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Friday, July 8, 2011

Americans can't afford cuts to Medicaid

Jessica Larochelle

Staff Writer

Weeks before the early August deadline to negotiate a deficit reduction package in Washington, and in the midst of state struggles to balance their budgets, a landmark study was released today that unequivocally demonstrates the value of the Medicaid program.

The results of The Oregon Health Insurance Experiment clearly indicate that expanding access to Medicaid “substantially increases health care use, reduces financial strain on covered individuals, and improves their self-reported health and well-being.” For a full summary of key findings and methodological highlights, please click here.

What is it that defines this study as truly groundbreaking? In short, it’s the methodology.

In the past, health economists have compared access to care and self-reported well-being across people who have insurance and the uninsured. These populations, however, tend to be different in many ways (e.g., education, employment, initial health, etc.) and teasing out the effect of health insurance alone could be challenging.

This study, however, was conducted using a randomized, controlled design—a gold standard in medical research, yet a methodology infrequently used in social policy research because, as the Center on Budget and Policy Priorities notes, “It is extremely unusual in social policy research, since it is unethical to deny people something like health care just for the sake of an experiment.”

However, in 2008, the state of Oregon opened up a waiting list for its Medicaid program, drawing names by lottery to fill the openings. For the first time, this random selection process allowed health economists the opportunity to study, apples-to-apples, people on the Medicaid program and people that remained uninsured. Researchers were able to really understand the implications of insurance status versus other confounding factors since the groups were divided by chance.

What’s more, as the Center for Children and Families notes, “A star-studded team of economists from MIT and Harvard, including advisors to Presidents Obama and Bush, conducted what is likely to become the gold standard for research with respect to the impact of Medicaid.”

This is a defining study in the field of health services research, and no doubt, will be cited for years to come. More importantly, the findings are crucial for seniors in nursing homes, people with disabilities living in the community, and children who need medical care. Proposals are on the table to dramatically slash the Medicaid program, either directly or through back-door mechanisms—like spending caps and blended rates—that would shift the burden of our struggling economy to those at greatest risk.

Negotiations are happening now, at both the state and federal level. Please help spread the word: Medicaid increases access to and use of health care, increases financial security, and improves health and well-being.

Americans simply can’t afford cuts to Medicaid.