off the charts
BEYOND THE NUMBERS
BEYOND THE NUMBERS
Oregon Medicaid Study Strengthens — Not Weakens — Case to Expand Medicaid
The New England Journal of Medicine reported encouraging new findings yesterday from the Oregon Health Study, a landmark, ongoing study of the state’s Medicaid program. Medicaid beneficiaries were more likely than the uninsured to access preventive care, such as mammograms for women, and they had far less financial hardship caused by health care spending. In fact, Medicaid coverage “almost completely eliminated catastrophic out-of-pocket medical expenditures.” The researchers also report significant improvements in diagnosing depression and diabetes among the Medicaid recipients they tracked. This report confirms earlier results from this study, which is often described as the “gold standard” for research. These findings are receiving praise, and for good reason. Both diabetes and depression are costly conditions; diagnosing and treating the diseases can improve patients’ health and quality of life. And eliminating catastrophic out-of-pocket costs means that Medicaid provides financial security for low-income adults in the same way that health insurance protects higher-income people from economic setbacks. The results come as some states are deciding whether to expand their Medicaid programs under health reform. Some critics of Medicaid already are citing some of the study’s results, such as the lack of statistically significant changes in diagnoses or treatment of high blood pressure or high cholesterol, as a reason to oppose expansion. A closer look at the Oregon study shows that its results don’t support that case, however. In addition to reporting the important positive results, the researchers were careful to explain their findings’ limitations, including small sample sizes that prevented them from concluding that some trends were statistically significant. For example, the authors did find that some patients’ cholesterol levels fell, but they suggested that they would need larger samples of patients to study before they could be certain of the findings’ validity. Similarly, they left open the possibility that improvements in high blood pressure among Medicaid recipients could be clinically significant. These results reflect an average of just 17 months of additional health insurance coverage. We know that Oregon’s Medicaid recipients used more preventive care — a factor that may take years, or even decades, to show its full effect on their health. Previous research, also published in the New England Journal of Medicine, pointed to reduced mortality in states five years after they expanded Medicaid to more low-income adults.
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