Fwd: qotd: Medicaid patients did improve in the Oregon Health Insurance Experiment

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-------- Original Message --------
Subject: qotd: Medicaid patients did improve in the Oregon Health
Insurance Experiment
Date: Tue, 4 Feb 2014 14:08:15 -0800
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



Health Affairs
February 2014
New Medicaid Enrollees In Oregon Report Health Care Successes And Challenges
Heidi Allen, Bill J. Wright and Katherine Baicker

In 2008 Oregon used a lottery to expand its Medicaid program for
low-income adults, Oregon Health Plan Standard (OHP).

For this study we conducted 120 qualitative interviews among Oregon
residents who had recently gained Medicaid coverage. Our purpose was to
better understand how newly insured patients did—and did not—interact
with the health care system

Group 1: Minimal Interactions With Health Care

Forty percent of the newly insured enrollees whom we interviewed did not
use their coverage much, if at all. Low users gave one of the following
four main reasons for not using their Medicaid benefits very often.

* Perception Of Good Health
* Confusion About Coverage
* Dissatisfaction With Care
* Access Barriers

Group 2: Regular Or Frequent Interactions With Health Care

The remaining 60 percent of respondents (called regular users) used
their insurance more than a time or two but reported varying degrees of
success.

* Regular Preventive Care And Minor Needs:

About one-tenth of the regular users took advantage of access to
preventive care and also received treatment for occasional illnesses or
injuries

* Immediate Health Improvement:

Another tenth of the regular users described an immediate transformation
in their health after they received insurance. These people all had
serious health problems that could be improved quickly, such as by
getting back on a previously effective medication or having an operation
that had been postponed because of lack of coverage. The members of this
group saw their new insurance coverage as directly related to an
improvement in their quality of life.

* Mixed Success:

Forty-four percent of regular users continued to experience challenges.
Some interviewees were able to get partial treatment—such as
prescriptions for chronic conditions—but had serious needs remaining.
Some reported feeling misunderstood by physicians or being unable to
build a relationship with a primary care provider. Others struggled with
very poor health that continued to deteriorate even with regular treatment.

* Success Over Time:

Finally, 39 percent of regular users reported that their health had
improved with insurance, but that it had taken time. They experienced
incremental benefits once they found and built a relationship with the
right doctor.

Often these users' problems were addressed in order of severity or
impairment. Lifestyle changes, such as modifications to diet and
exercise, were not discussed until their acute symptoms had improved.
Many of the positive changes that they reported were relatively recent.

http://content.healthaffairs.org/content/33/2/292.abstract


Comment: The "Oregon Health Insurance Experiment" made possible the
comparison of uninsured patients with Medicaid patients by the natural
experiment in which Medicaid patients were selected by lottery from a
single population. The initial study reported was not powered to detect
changes in health outcomes, but opponents of reform used the lack of
demonstrable outcome differences to claim that Medicaid provides no
health benefits for the patients enrolled. This new study of these
Oregon Medicaid beneficiaries confirms that the claim of no health
benefit was an outrageous extrapolation on the part of the opponents of
ACA and Medicaid.

The majority of the 60 percent of the Medicaid beneficiaries who were
regular users of care significantly benefited from the program.
One-tenth experienced immediate health improvement, one-tenth benefited
from preventive care and occasional acute care, 39 percent experienced
incremental benefits over time, and 44 percent continued to experience
challenges though many of them were able to receive partial treatment.

Some of the reasons given by the 40 percent of the Medicaid
beneficiaries who did not use much health care are of concern. Some
reasons relate to well-known problems with Medicaid being considered a
second-rate welfare program, that is chronically underfunded, and that
has access problems due to an insufficient participation by health care
professionals.

We can conclude that Medicaid has some definite problems, but we also
can refute the opponents of Medicaid and state that it is far better to
be insured, even with Medicaid, than not to be insured at all. At the
same time, we can also state that mixed results for a portion of the
study group should be motive enough for us to advocate emphatically for
a higher quality program for everyone - an improved Medicare for all.