Wonkbites: Oregon Medicaid Edition

by Adrianna McIntyre 

If you live anywhere in the neighborhood of the health policy wonkosphere, you’ve heard about the Oregon Health Insurance Experiment results released on Wednesday. If not, it’s sufficient to know that this report is—or is at least perceived to be—a BFD. This week’s Wonkbites is a roundup of my take on the must-read coverage.

I don’t have much to add that wasn’t superbly addressed by one or more of the authors below. I didn’t have preconceived expectations about Medicaid measurably improving physical health over two years—it’s a pretty short time horizon; to be honest, I’m somewhat surprised by the surprise. The chronic conditions that drive the nation’s health costs? Those aren’t quick-fixes.

  1. COHN: “That has me wondering: Did they read read the same study that I did?” Jonathan Cohn makes a point that really needs to be made more loudly: there are outcomes besides improved physical health that we’re looking for. Like the “insurance” part of health insurance: Baicker et al found that the expansion reduced catastrophic out-of-pocket health spending by 80% among those who received coverage. That’s exactly what health insurance is supposed to do—and what Medicaid in Oregon is doing.
  2. CARROLL/FRAKT: “So chill, people. This is another piece of evidence. It shows that some things improved for people who got Medicaid. For others, changes weren’t statistically significant.” Check out this breakdown for a deeper dive into the weeds—what we can infer from statistical non-significance (spoiler: not much, but also not failure), why the selected process measures aren’t perfect, and how this stacks up against past research. Also see their follow-up coverage here and here
  3. BARRO: “While Medicaid is clearly good for some things, it was supposed to be good for all of the measures tracked.” Josh Barro offers a smart take: what we learn from the Medicaid experiment probably isn’t limited to Medicaid. There haven’t exactly been a plethora of randomized controlled trials in health care coverage (the RAND health insurance experiment being the noted exception, but that had no “uninsured” arm). That’s a really, really important point—and so are other arguments he makes in the piece.
  4. YGLESIAS: “Here’s the study I want to see: A state considering expanding Medicaid … should instead spend half that money on giving Medicaid to half the people and give out the rest of the money via cash grants.” Matt Yglesias offers a somewhat unorthodox idea for future Medicaid research, centering on the premise that healthy people don’t actually spend very much on health care—so their health status might be improved in other ways if they received cash payments instead of insurance. It’s an intriguing proposal.
  5. KAPUR: “‘This is an astounding finding — that is a huge improvement in mental health,’ said Gruber, who is also an architect of Obamacare.” In the arguments over statistical significance and the importance of blood pressure and glycated hemoglobin levels, measured improvement in mental health has been largely glazed over—which has broader implications for quality of life. If I was the betting type, I’d say we’re going to see more discussion of the relationship between mental health and physical health next week.

Bottom line? Keep calm and collect more data.

Adrianna is a graduate student in public policy and public health at the University of Michigan.
Follow her on Twitter @onceuponA or subscribe to the blog.


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