New Medical Study Reveals People on Medicaid are not significantly healthier

[editec]

I thought you went on Medicaid if you were poor and had medical bills that needed covering? Was I wrong?

In other words, Medicaid is for poor people who become sick, not something that pays for preventive care for all poor people.

Anyway, from the link that only checked three things: "glycated hemoglobin, a measure of blood sugar levels; blood pressure; and cholesterol levels." Those all affect your health but they are not caused by your health. Cause-effect relationship is backwards there.

What they are is measures of how you are eating and how much execise you're getting. So a more accurate title would be: [I]"Study shows that people on medicaid do not change their eating habits or physical activity levels when enrolled[/I]"

Now I tracked down the actual study, and here is what it said:

"We find that
Medicaid coverage lowered rates of depression and nearly eliminated catastrophic out of
pocket medical expenditures. We find no statistically significant effect of Medicaid on
the prevalence, diagnosis, or medication of hypertension or high cholesterol. Medicaid
coverage significantly increased the diagnosis of diabetes and use of diabetes medication,
but we observe no significant effect on glycated hemoglobin levels or the prevalence of
diabetes."

As is so often done, data suggests one thing, Partisans try to lie about what the data means.

 

[Bomboozle]

I thought you went on Medicaid if you were poor and had medical bills that needed covering? Was I wrong?

In other words, Medicaid is for poor people who become sick, not something that pays for preventive care for all poor people.

Anyway, from the link that only checked three things: "glycated hemoglobin, a measure of blood sugar levels; blood pressure; and cholesterol levels." Those all affect your health but they are not caused by your health. Cause-effect relationship is backwards there.

What they are is measures of how you are eating and how much execise you're getting. So a more accurate title would be: [I]"Study shows that people on medicaid do not change their eating habits or physical activity levels when enrolled[/I]"

Now I tracked down the actual study, and here is what it said:

"We find that
Medicaid coverage lowered rates of depression and nearly eliminated catastrophic out of
pocket medical expenditures. We find no statistically significant effect of Medicaid on
the prevalence, diagnosis, or medication of hypertension or high cholesterol. Medicaid
coverage significantly increased the diagnosis of diabetes and use of diabetes medication,
but we observe no significant effect on glycated hemoglobin levels or the prevalence of
diabetes."

As is so often done, data suggests one thing, Partisans try to lie about what the data means.

The point is that expanding Medicaid does not improve health. Read on:

"The most overlooked finding is that the uninsured already receive considerable health care. On average, the uninsured had 5.5 office visits annually, used 1.8 prescription drugs and visited the emergency room once. Almost half (46 percent) said they "had a usual place of care" and 61 percent said they "received all needed care" in the past year. About three-quarters (78 percent) who received care judged it "of high quality." Health spending for them averaged $3,257.

True, when people were covered by Medicaid, many of these figures rose. The number of office visits went to 8.2; the number of drugs, 2.5; the share of patients with a usual place of care, 70 percent; the proportion receiving all needed care, 72 percent. Preventive care also increased. The share of patients receiving screening for cholesterol moved from 27 percent for the uninsured to 42 percent; the share of women over 50 having mammograms jumped from 29 percent to 59 percent; the share of men over 50 getting PSA tests for prostate cancer doubled from 21 percent to 41 percent. Spending rose to $4,429.

Unfortunately, the added care and cost didn't much improve people's physical health. The study screened for high blood pressure, high cholesterol, diabetes and the risk of a future heart attack or stroke. There were no major detected differences between the uninsured and Medicaid recipients. There was more treatment for diabetes, though no difference between the two groups on a key indicator of the disease.

The only major health gain was psychological. Depression dropped from about 30 percent to 21 percent between the groups. One reason may have been that Medicaid recipients don't fear huge medical bills. Their out-of-pocket health costs were $337. For the uninsured, out-of-pocket costs were 64 percent higher. (Presumably, most non-out-of-pocket costs for the uninsured were covered by free clinics, charity care and uncollected debt.)

Read more: Overselling ObamaCare | RealClearPolitics


It appears people on Medicaid do have an advantage over the rest of the middle class, who are not only worried about how they will afford their healthcare premiums next year, but how they will medical bills not covered by their insurance plan.

 

[Dont Taz Me Bro]

The study seems flawed. Those on medicaid are poor. Poor people are more susceptible to chronic illness due to everything from poor diet to substandard living and working conditions.

That doesn't make the study flawed. That's the justification.

 

[Greenbeard]

Grants for health centers and other capital improvements are not the issue here. People are the end user, and the question is how to best serve them so they are healthier. Existing health centers are already underfunded, so instead of added more people onto the Medicaid program, how about directing that money to keep the light on by funding existing programs that work and expanding their outreach into the community?

If you want to increase funding for community health centers, the single best way to do that is to expand Medicaid. Medicaid is a funding stream--any suggestion for "directing that [Medicaid expansion] money" already implicitly accepts that the expansion has or should take place.

And it's always been the case that some doctors and other service providers limit the number of Medicaid patients they accept, if they accept them at all, because of the low reimbursement rate. I doubt that will change under Obamacare. Even Obama's own 2014 budget includes cuts to Medicaid programs.

Medicaid primary care reimbursement rates are rising substantially next year.

So I don't want to check either of your boxes, instead I want to check the box that gives local communities and states the control to decide how to best use federal funding to maintain and expand existing local health centers that provide services to local communities.

That box is called "Medicaid."

 

[Bomboozle]

If you want to increase funding for community health centers, the single best way to do that is to expand Medicaid. Medicaid is a funding stream--any suggestion for "directing that [Medicaid expansion] money" already implicitly accepts that the expansion has or should take place.

Sorry, but I respectfully disagree. Medicaid is first and foremost a service provided to participants and paid for by states and the federal government. See Financing & Reimbursement | Medicaid.gov The grants are a fraction of what it will cost the federal government to add thousands, if not millions onto Medicaid. See CMS1187451 - Centers for Medicare & Medicaid Services for the current status of grants. With the additional of "minimum essential health benefit" requirement to service providers, it can be anticipated that Medicaid costs will increase exponentially.

Which brings me to your next point:

"Medicaid primary care reimbursement rates are rising substantially next year."

Don't hold your breath on that. Currently budget talks include decreasing, not increasing, Medicaid reimbursement. If you can show evidence to the contrary, I'd love to see it.

So I don't want to check either of your boxes, instead I want to check the box that gives local communities and states the control to decide how to best use federal funding to maintain and expand existing local health centers that provide services to local communities.

That box is called "Medicaid."[/QUOTE]

Nope, that box is called "Repeal Obamacare"

 

[Greenbeard]

Sorry, but I respectfully disagree. Medicaid is first and foremost a service provided to participants and paid for by states and the federal government.

...that's the point. It reimburses service providers (who provide services to vulnerable populations in a more or less payer-blind fashion) for services rendered, allowing them to keep the lights on and continue serving the community. That's why it's a critical funding stream for safety net providers, who are already responsible for tending to much of the expansion population. The difference is that after the Medicaid expansion they'll have a steady funding stream to support that work.

Don't hold your breath on that. Currently budget talks include decreasing, not increasing, Medicaid reimbursement. If you can show evidence to the contrary, I'd love to see it.

I misspoke; the Medicaid reimbursement hikes for primary care providers (averaging a 73% increase) begin this year, not next.

Nope, that box is called "Repeal Obamacare"

Certainly, the best way to "maintain and expand existing local health centers" is to repeal the law that does exactly that.

 

[Bomboozle]

Don't hold your breath on that. Currently budget talks include decreasing, not increasing, Medicaid reimbursement. If you can show evidence to the contrary, I'd love to see it.

I misspoke; the Medicaid reimbursement hikes for primary care providers (averaging a 73% increase) begin this year, not next.

Your link states only:

To help ensure that access in Medicaid expands to meet anticipated higher demand for care, the health reform law requires states to pay certain physicians Medicaid fees that are at least equal to Medicare’s for a list of 146 primary care services in 2013 and 2014. The idea is to attract new physicians to Medicaid and provide greater support for physicians who already participate. As a result, Medicaid fees paid to certain physicians for primary care services will increase by an unprecedented 73%, on average, in 2013. The cost of fee increase is fully federally funded in 2013 and 2014.

Great -- so Obamacare is forcing states to pay higher Medicaid fees with the "hope" it will attract more physicians. So why are physicians turning away Medicaid patients? And let's go back to my original post: where is the evidence that Medicaid programs benefits participants?

Nope, that box is called "Repeal Obamacare"

Certainly, the best way to "maintain and expand existing local health centers" is to repeal the law that does exactly that.[/QUOTE]

It is the middle class who will pay for Obamacare and Medicaid. At the same time, it is the middle class who will see their own healthcare costs go through the roof and any disposable income they had disappear. Obamacare places the financial burden squarely on the middle class. That is not the way to sustainable healthcare reform and arguably there will still be uninsured next year. What will change is the middle class will be the ones priced out of the healthcare market, not low-income populations. I still check the box "repeal Obamacare."

 

[Greenbeard]

Great -- so Obamacare is forcing states to pay higher Medicaid fees with the "hope" it will attract more physicians.

The differential between the state's rates and Medicare rates gets 100% FFP; the cost isn't borne by the states.

So why are physicians turning away Medicaid patients?

I don't think it's any secret that the Medicaid population is generally sicker, less lucrative than privately insured patients, and more difficult to deal with for a range of cultural/socioeconomic reasons. In that sense, the expansion population will likely be easier to deal with on average than the traditional Medicaid population.

And let's go back to my original post: where is the evidence that Medicaid programs benefits participants?

The study in the OP did show clear benefits: better access to health services, clear financial benefits for beneficiaries (who became much less likely to be bankrupted by their health conditions), and surprisingly large improvements in self-reported depression and quality of life. Some of the other indicators showed interesting results, even if they weren't definitive--for instance, the authors noted that the decrease in hypertension experienced by those who enrolled in Medicaid would be considered "clinically significant," though they didn't rise to the level of statistical significance (you can find all kinds of debate as to whether the study was underpowered to answer some of these questions due to the size of the subgroups on which it had to rely). But since the study unambiguously showed some significant benefits, I don't know where your question is coming from.

I suspect what you're asking is really some variant of whether access to health services (which improved for those enrolled in Medicaid) is good for people. If the answer is no, that's a serious indictment of the health care delivery system. There's no question that it falls short--not for this payer or that payer but for everyone. Starting to improve the actual delivery of care in the U.S. is a huge thrust of the ACA and a necessary complement to the coverage piece of the law.

 

[Bomboozle]

The differential between the state's rates and Medicare rates gets 100% FFP; the cost isn't borne by the states.

You are confusing your programs. We are talking about Medicaid, not Medicare, which services a completely different populations and has different funding eligibility requirements funding streams.

So why are physicians turning away Medicaid patients?

I don't think it's any secret that the Medicaid population is generally sicker, less lucrative than privately insured patients, and more difficult to deal with for a range of cultural/socioeconomic reasons. In that sense, the expansion population will likely be easier to deal with on average than the traditional Medicaid population."

The Medicaid study (and many other studies as well) challenges your assumption that Medicaid populations are sicker. But I agree that serving that population is less lucrative, which is exactly my point -- expanding Medicaid will not produce healthier people and will not be a cost-effective delivery system. Local and regional healthcare systems are much better equipped to address cultural and socioeconomic specific to their patent base -- fund these systems without all of the federal regulations. I have no idea what you mean when you write the expansion population will "likely be easier to deal with on average than the 'traditional' Medicaid population. Easier than traditional Medicaid population? How so?

The study in the OP did show clear benefits: better access to health services, clear financial benefits for beneficiaries (who became much less likely to be bankrupted by their health conditions), and surprisingly large improvements in self-reported depression and quality of life. Some of the other indicators showed interesting results, even if they weren't definitive--for instance, the authors noted that the decrease in hypertension experienced by those who enrolled in Medicaid would be considered "clinically significant," though they didn't rise to the level of statistical significance (you can find all kinds of debate as to whether the study was underpowered to answer some of these questions due to the size of the subgroups on which it had to rely). But since the study unambiguously showed some significant benefits, I don't know where your question is coming from. I suspect what you're asking is really some variant of whether access to health services (which improved for those enrolled in Medicaid) is good for people. If the answer is no, that's a serious indictment of the health care delivery system. There's no question that it falls short--not for this payer or that payer but for everyone. Starting to improve the actual delivery of care in the U.S. is a huge thrust of the ACA and a necessary complement to the coverage piece of the law.[/QUOTE]

If for no other reason (which there are many valid ones) my point remains that Medicaid expansion is an expansion of a wasteful ineffective healthcare system that will not produce healthier people. And it is not acceptable that the expansion be paid for on the backside of the middle class.

 

[Greenbeard]

You are confusing your programs. We are talking about Medicaid, not Medicare, which services a completely different populations and has different funding eligibility requirements funding streams.

Medicaid primary care rates this year are getting bumped up to Medicare rates--a significant increase for them.

The increase is being paid for entirely by the federal government, not the states. Clear?

Local and regional healthcare systems are much better equipped to address cultural and socioeconomic specific to their patent base -- fund these systems without all of the federal regulations.

Better equipped than what? What you're describing here is effectively the Medicaid delivery system. Safety net providers, county health systems, other private providers in the area. You're describing them as somehow distinct from the way Medicaid works when they serve Medicaid--for some of them, they primarily cater to underserved populations.

I need to start keeping track of the number of times in this thread you've effectively made the point that "Medicaid is better than Medicaid."

I have no idea what you mean when you write the expansion population will "likely be easier to deal with on average than the 'traditional' Medicaid population. Easier than traditional Medicaid population? How so?

The expansion population is going to consist of childless adults (i.e. those who've been denied categorical eligibility for Medicaid in the past), a group that on average will have better health status and in some cases higher income than traditional Medicaid populations.

If for no other reason (which there are many valid ones) my point remains that Medicaid expansion is an expansion of a wasteful ineffective healthcare system that will not produce healthier people.

Medicaid is insurance, it simply reimburses for care. If you think the health care in this country isn't worth paying for, that's a somewhat bigger issue than whether this particular population should get access to it. But, as I said, the ACA focuses on both: improving access but also improving care delivery (with an eye towards the particular needs of the kinds of folks served by Medicaid).

 

[Bomboozle]

"The increase is being paid for entirely by the federal government, not the states. Clear?"

Completely, and to my point -- the federal government is overexpanding a bureaucratic program that has questionable efficacy. It's called Medicaid. And who exactly is paying for the expansion? The middle class is.

"Better equipped than what? What you're describing here is effectively the Medicaid delivery system. Safety net providers, county health systems, other private providers in the area. You're describing them as somehow distinct from the way Medicaid works when they serve Medicaid--for some of them, they primarily cater to underserved populations."

Consider local programs that have already proved successful -- San Francisco's "Healthy San Francisco" program is a perfect example of how a city put together a program that works. The SF program is also a program that is 70% funded by local stakeholders, including companies that have a presence in San Francisco as well as healthcare clinics. The program wraps around existing Medicaid programs and is available to low-income residents with incomes that are too high to qualify for Medicaid, exactly the same population as an expansion of Medicaid and then some. I suspect there are other successful programs out there.

"The expansion population is going to consist of childless adults (i.e. those who've been denied categorical eligibility for Medicaid in the past), a group that on average will have better health status and in some cases higher income than traditional Medicaid populations."

Hmmmmmm...... "a group that on average will have better health status...." So you are saying the same thing the Oregon study did? And given that the Medicaid expansion is based on income, it's a given that those earning 133% FPL will have "higher incomes" than traditional Medicaid populations.

"If you think the health care in this country isn't worth paying for, that's a somewhat bigger issue than whether this particular population should get access to it. But, as I said, the ACA focuses on both: improving access but also improving care delivery (with an eye towards the particular needs of the kinds of folks served by Medicaid)."

What I'm saying is this: Obamacare got it wrong. There is no guarantee that Medicaid expansion will produce healthier people. Medicaid is already established, I've never argued that point, but expanding an overburdened system is the problem. At least the Supreme Court got that part right last year when they ruled that Obamacare overstepped its authority by demanding states expand Medicaid.

Final comment. Bottom line? Greenbeard, you are for Medicaid expansion as the most cost-effective and efficient way to provide healthcare because it's an established delivery system, and you believe the promised reimbursement increases to service providers will solve the inequality of payment. I respectfully agree to disagree with your arguments. I believe that instead of expanding Medicaid, funding local programs (like the S.F. program) are more cost-efficient way to service low-income populations. What the Oregon study (and other studies) support is that there is more to being healthy than just having access to Medicaid insurance. And no, Medicaid is not better than Medicaid - what I'm saying is expanded Medicaid is not better than Medicaid.

One year from now we will all find out whether Obamacare was a success or debacle. In the meantime, I'll still check the "Repeal Obamacare" box.

 

[whitehall]

An RTC (randomized control trial) in Oregon? How could Medicaid possibly impact issues like blood sugar, cholesterol and blood pressure?

 

[JakeStarkey]

The study seems flawed. Those on medicaid are poor. Poor people are more susceptible to chronic illness due to everything from poor diet to substandard living and working conditions.

-- if low-income populations are more susceptible to chronic illness, why didn't the group covered under Medicaid reveal those illnesses and show measurable improvement because they have access to healthcare?

Because the group has already been a part of a long time exposure to poor health care.

And you think Medicaid is going to get them better, when the groups is chronically ill?

Medicaid is doing a great job in keeping them from getting sicker.

And some idiot is sure to post next that no no no the study is that or this or whatever. Screw it. It found exactly what one would expect to find in a chronically ill group.

 

[koshergrl]

The study seems flawed. Those on medicaid are poor. Poor people are more susceptible to chronic illness due to everything from poor diet to substandard living and working conditions.

Nope, the study isn't flawed.

They followed for two years, they used a huge sample. Increased medicaid coverage resulted in more expense and absolutely no increase in health, aside from a lessening of stress directly attributable to not having to worry about paying for their visits to the doc every week.

 

[koshergrl]

An RTC (randomized control trial) in Oregon? How could Medicaid possibly impact issues like blood sugar, cholesterol and blood pressure?

The idea is that getting it diagnosed quicker and spending more time having blood work done and having the doc yap at you about your diet will make people healthier.

And while they definitely got more diagnoses of those things (since they screen for them) there was no increase in overall health.

But the increase in cost was quite noticeable. Go figure.

 

[JakeStarkey]

Adjusted inflation annual rate so far for the year is 2.8% for medicare. Some are very low information on the rate of inflation. This will help.

http://inflationdata.com/Inflation/Inflation_Rate/CurrentInflation.asp

 

[Greenbeard]

Consider local programs that have already proved successful -- San Francisco's "Healthy San Francisco" program is a perfect example of how a city put together a program that works. The SF program is also a program that is 70% funded by local stakeholders, including companies that have a presence in San Francisco as well as healthcare clinics. The program wraps around existing Medicaid programs and is available to low-income residents with incomes that are too high to qualify for Medicaid, exactly the same population as an expansion of Medicaid and then some. I suspect there are other successful programs out there.

But what about it is innovative or impressive? The answer is that it's primarily a model of delivery, particularly primary care--that is, it's built on a medical home model. And that's great. That's a model that's increasingly held up as a key strategy for improving care and health, as well as improving capacity and access.

But San Francisco didn't invent that, nor are they only ones doing it. In fact, counties all over California are now building up their own medical home and care coordination infrastructure in partnership with local clinics and hospitals. And they're doing it by drawing down billions in Medicaid matching funds in anticipation of full implementation of the ACA. Here, you can browse through county narratives of what they're doing at the local level to implement medical homes and improve care coordination. You'll find it sounds quite a bit like what San Francisco has been doing. But it's now reaching millions of people.

And given that the Medicaid expansion is based on income, it's a given that those earning 133% FPL will have "higher incomes" than traditional Medicaid populations.

Medicaid has historically been a program based on categorical eligibility. People who don't fit into one of the coverage categories (e.g. childless adults) are generally ineligible for Medicaid, regardless of how poor they are. That's what's changing.

I believe that instead of expanding Medicaid, funding local programs (like the S.F. program) are more cost-efficient way to service low-income populations.

And I still haven't quite been able to figure out how you think the former differs from the latter.

What the Oregon study (and other studies) support is that there is more to being healthy than just having access to Medicaid insurance.

I believe I've been saying that all along. In fact, I've never made a secret of the fact that I find the ACA's delivery system reform provisions much more interesting than the straightforward coverage expansion pieces. The reality is they go hand in hand--coverage needs to be expanded to get care to people and to pay for it, but the systems and processes by which care is delivered need to be improved (for everyone, regardless of whether their insurer is Medicaid or Blue Cross).

And states get that. We've seen that California's reform approach is just as much about improving care delivery (including by bolstering medical home models similar to what Healthy San Francisco uses) as it is expanding coverage. The same is true for Oregon, for that matter. They launched a major redesign of Medicaid financing and delivery in the state beginning last year when they restructured Medicaid around what they're calling coordinated care organizations.

It's happening all over the country. We're in the middle of a major wave of innovation and reform, partly driven by the urgency of the coming coverage expansions and partly driven by the fact the deficiencies in the way we pay for and deliver care are something we just can't afford anymore. Repealing a major impetus for and facilitator of these reforms at this point in history would be insanity.