Does Medicaid Expansion Improve Healthcare Outcomes?

 

Things are not always what they seem. Most people would expect that giving the uninsured Medicaid healthcare coverage would improve their health. It might seem that having any form of healthcare insurance is better than having none at all.

A recent study published in the obscure journal Diabetes Care would seem to back up most people’s assumptions. Noam N. Levey, writer for the Tribune newspapers, touts the results of a study by Dr. Harvey Kaufman, senior medical director of Quest Diagnostics. The title of the article boasts “Diabetes Study Gives Boost to ACA’s Medicaid Expansion.”

The results of this study indicate that in states that expanded Medicaid under the ACA there were more patients with newly-identified diabetes than in states that did not expand Medicaid. The study reports the number of Medicaid-enrolled patients with newly identified diabetes increased by 23% in the 26 states (and District of Columbia) that expanded Medicaid compared with an increase of 0.4% in the 24 states that did not expand Medicaid during this period.

The study concludes by suggesting that in the states that expanded Medicaid under the ACA, an increased number of Medicaid patients with diabetes are being diagnosed and treated earlier. The authors assume this could be anticipated to lead to better long-term outcomes.

Levey draws additional conclusions: “Low income patients with diabetes are getting better access to medical care in states that have expanded Medicaid coverage through the Affordable Care Act, suggests a new study that provides one of the first indications of the health impact of the sweeping law.”

Study Analysis

As a medical doctor I’m trained to do critical analysis of scientific studies to determine the legitimacy of their findings. Not all research is created equal. There are design flaws and sources of bias in any study and therefore no one should accept as gospel any study without careful review as well as patience to see if other studies will draw the same scientific conclusions.

There are some issues in this study that immediately draw concern. First, the study was done by Quest Diagnostics, a large national firm doing laboratory studies on millions of Americans that stands to benefit greatly by any expansion of Medicaid. The more states that expand Medicaid, the more patients that Quest will be sent for laboratory testing paid for by the taxpayers. This obvious bias should be considered in evaluating any conclusions of their study.

Second, the study states, “By definition, all of the patients who were new to Medicaid in 2014 had used medical services and Quest Diagnostics laboratory services in 2013.” This would seem to nullify the conclusion that these patients were receiving medical treatment only after the expansion of Medicaid in 2014. They would not have been in the system in 2013 had they not been already receiving healthcare.

Third, the study has no data to back up any claims of improved healthcare outcomes. It only examined data that showed newly diagnosed diabetes – not control of blood sugar levels. It assumes this will lead to better long-term outcomes.

What about ideological bias of the researchers? The study’s lead author, Kaufman, said, “Clearly, the expansion of Medicaid has had a tremendous impact. It has helped a lot of people, and frankly helps anyone who pays.” Since Medicaid patients pay nothing for healthcare it is difficult to discern the meaning of this last statement.

The Oregon Study

The results of an earlier study in Oregon in 2008 refute the conclusions being drawn by the researchers in this study and the reporter who wrote this article. The study, known as The Oregon Health Insurance Experiment, is an ongoing study, which has already revealed significant information.

It came about for unbiased reasons: the State of Oregon was faced with the need to expand Medicaid but insufficient money to pay for everyone. So they held a lottery for the low-income, uninsured adults. Then they studied the two resulting populations – those with newly-enrolled Medicaid and those who remained uninsured.

Thus far researchers have learned that having Medicaid had no effect on measurements of blood pressure, blood sugar, and cholesterol. Medicaid did seem to reduce rates of depression by 30% but increased the probability of being diagnosed with depression. Medicaid significantly increased the probability of being diagnosed with diabetes and the use of diabetes medication, but did not have the expected impact of lowering blood sugar.

So the results of the Quest study are actually in agreement with the Oregon study regarding the probability of being diagnosed with diabetes – but the Oregon study shows this had no impact on the healthcare outcomes of those on Medicaid.

Therefore we can see that this new study actually says nothing new at all! It is meaningless to show that more people are being diagnosed with diabetes if their healthcare outcomes don’t change. Furthermore, there is nothing here to conclude that access to healthcare has improved by Medicaid expansion. All of the patients in the Quest study were already receiving healthcare since they were all in the Quest data banks by study definition.

I’m all for Medicaid expansion if it can be proven that access to treatment and healthcare outcomes are improved. So far, there is no proof of either one.

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