The effectiveness of Medicaid, as compared to private insurance, has long been a matter of debate, but in recent years conservative critics have not-so-quietly suggested that the program provides no improvement to beneficiaries' health whatsoever.
With a new batch of states ready to expand Medicaid following the 2018 midterms, a new study from America's Health Insurance Plans (AHIP) looks to decidedly put that concern to bed.
Medicaid beneficiaries have far better health outcomes than uninsured individuals, particularly those with chronic conditions like asthma, diabetes or mental health issues, AHIP found. Under Medicaid, asthma patients received inhalers, diabetes patients received regular monitoring checks and mental health patients were able to receive some combination of medication and psychotherapy, often at rates comparable to commercial plans.
Uninsured patients usually received none of those interventions.
“Health insurance providers know that Medicaid must work for the people who rely on it—and the hardworking taxpayers who pay for it,” said Matt Eyles, AHIP president and CEO, in a release. “This new report proves that Medicaid works, and adds to a growing body of evidence that Medicaid is an essential, critical safety net for millions of Americans.”
Crucially, not only does Medicaid improve health outcomes for the individuals it covers, but it also controls costs for hospitals and other practices. When uninsured individuals don't get the treatment they need, they inevitably end up in the emergency room with a worsened condition. Those hospitals are then forced to provide more costly procedures than they would have if routine care were followed, much of which goes uncompensated.
"Asthma, diabetes and serious mood disorders affect tens of millions of Americans, and cost hundreds of billions of dollars to treat. Medical care and emergency room costs are far higher if patients do not have the access to care needed to help them successfully manage their condition," AHIP wrote in the report.
The concept that healthcare coverage improves the health of those it covers doesn't sound revelatory—and it isn't. Yet ever since a 2013 study conducted in Oregon found questionable results in the state's Medicaid population, conservatives have cast doubt on the program's effectiveness.
During the Republican presidential primaries in 2015, for instance, Sen. Ted Cruz, R-Texas, said on the campaign trail that health outcomes get “markedly worse when people get on Medicaid” and that “people’s life expectancy goes down on Medicaid.”
Fellow Texan Rick Perry agreed, saying in a speech that "We spend $450 billion a year on Medicaid. And yet, health outcomes for those on Medicaid are no better than those who have no health insurance at all. Instead of reforming Medicaid, the president expanded it under Obamacare.”
Even at the time, these were misreadings of the Oregon study. As the authors explained, their study found no causal link between Medicaid and health outcomes—it just showed that uninsured individuals at that point were in better health than those covered under either Medicaid or private insurance. Even the conservative American Enterprise Institute acknowledged the distinction.
AHIP's study took a more targeted look at the program, examining specifically diabetes patients, asthma patients and mental health patients with three different insurance states: uninsured, commercially insured or covered under Medicaid.
Among these chronically ill patients, AHIP found not only that health outcomes of Medicaid beneficiaries were far superior to those of the uninsured, but also health outcomes were more or less on par with those of commercially insured patients.
"Overall, across three major disease states, people with Medicaid health plan coverage had clinical experiences consistent with their peers having commercial healthcare coverage. Both insured groups had superior clinical experiences relative to people lacking insurance," the report said. "The majority of patients having Medicaid health plan coverage were treated for their conditions, and the treatment they received was comparable to that received by the commercially insured."