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Misguided Attack on Medicaid

Senator Orrin Hatch (R-UT) this week made several unfair and inaccurate attacks on Medicaid. Most egregiously, in his speech Wednesday at the Heritage Foundation, he repeated a recent claim by American Enterprise Institute analyst Scott Gottlieb that “Medicaid is worse than no coverage at all.”

Gottlieb based his claim on several studies, such as one of patients with throat cancer that found Medicaid patients and uninsured people were both 50 percent more likely to die than privately insured patients. But, as a recent commentary in The New England Journal of Medicine explains, these studies are “beset by analytic problems.”

Studies that appropriately adjust for the fact that Medicaid enrollees tend to be both sick and poor, as well as other factors that can skew results, “have consistently found that Medicaid coverage leads to health improvements,” conclude the authors, who include noted health policy experts Austin Frakt and Uwe Reinhardt.

George Washington University professors Leighton Ku and Christine Ferguson also point out that Gottlieb confuses causation and correlation: “Patients often become eligible for Medicaid as a result of being sick,” they write. “It is not that Medicaid enrollment causes ill health, but that ill health leads to Medicaid enrollment.”

To be sure, adequate access to physicians — particularly specialists — remains a concern in Medicaid, as a new study notes. But Ku and Ferguson cite abundant evidence that people have much better access to health care when they have Medicaid than when they are uninsured (see graph).


They also cite studies showing that Medicaid and its companion program, the Children’s Health Insurance Program:

  • have reduced infant mortality rates, child morbidity rates, and incidences of low birth-weight children,
  • improve the health of adults and children with chronic conditions and special health care needs, and
  • support preventive care and early diagnosis.

And, as we’ve pointed out, it costs Medicaid much less than private insurance to cover people with similar health status.

Given these facts, Senator Hatch’s claim that Medicaid is a “health care gulag” is nonsense.