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Two years after receiving Medicaid coverage, the mental health and financial well-being of the beneficiaries fared substantially better than a random uninsured group of the same low income. But clear physical health benefits among scheme recipients have yet to be seen.

By Louise Kelly on May 2, 2013

It is extremely hard to measure the impact and comparable benefits of providing health insurance. Yet this ideological debate – nay argument – has been forefront among US government and citizens for some years now.  By January 2014, millions of low earning adults will gain health insurance coverage through Medicaid in one of the farthest-reaching provisions of the the Affordable Care Act. Will Obama’s healthcare law be everything that it promises to be?

A new study released on Wednesday in The New England Journal of Medicine has attempted to provide fresh insight into the very real health benefits this insurance coverage might have on low-income adults and how access to – and cost of – care are impacted. The study, called the Oregon Health Study, compares thousands of low-income people in Oregon who received access to Medicaid with an identical segment of the population that did not.

Mixed results

The Oregon Medicaid experiment was initiated in 2008, when the state opened a waiting list for a limited number of new spots in the Oregon Health Plan Standard – pulling names from a waiting list of nearly 90,000 uninsured people to fill 10,000 openings. For this latest study, researchers at the Harvard School of Public Health and Massachusetts Institute of Technology conducted more than 12,000 in-person interviews and health exams of lottery participants in the Portland area about two years after the lottery.

Confirming previous findings released by the researchers in 2011, the recent analysis has revealed that adults covered by Medicaid increased their use of a broad number of diagnostic health services, like mammograms and cholesterol tests. The researchers also found that the rate of depression dropped by 30 percent among people with Medicaid versus people without insurance who screened positive for depression.  Meanwhile, security in finances soared – two factors that some authors say may possibly be linked.

But insurance hasn’t necessarily made the Oregon citizens any healthier.  Although the short follow-up period (a mere two-years in negligent in health research terms) from the insurance lottery and the small number with chronic conditions in the study sample may be blamed for lending some inaccuracy to the results, the outcome nonetheless suggests that Medicaid coverage did not make these patients much healthier physically, judging by three widespread but treatable ailments. Although the probability that a person would receive a diagnosis of diabetes, for one, and be treated was significantly increased, it did not reduce blood sugar levels noticeably.  Furthermore, insurance coverage did not affect the prevalence or diagnosis of hypertension or high cholesterol, or the use of drugs used to treat those conditions.

Has anything actually changed?

Media coverage on the findings of this study are already rampant and as diverse as the quarrels on the topic that have led to this point. As one of the two principle investigators of the study, Katherine Baicker of the Harvard School of Public Health, says, the findings are like a health insurance ink blot - advocates and insurance opponents will see in it whatever they need to validate their existing position.  The lack of any measurable effect on health outcomes will compete against Medicaid’s part in reducing stress and its value as a financial bolster.

Another salient point that Baicker highlights is that this study and findings from earlier research on the Oregon experiment should crush the ideal that expanding Medicaid will save money because “the program costs money; people consume more health care.”  During the study, it was found that those who gained Medicaid coverage spent (about 35 percent) more on health care, making more visits to doctors and trips to the hospital, negating previous predictions that insured patients would be diagnosed, treated and then no longer have a need for the service. 

But perhaps, as indicated above, it is still too early to say whether the health scheme is as effective as its campaign.  “One thing it doesn't tell us is what happens three, four, five and six years later, and that's important because so many of the benefits of health care accumulate over time,” said Dr. David Meltzer, associate professor of medicine, economics and public policy studies at the University of Chicago, who was not involved in the study.