Archive for July, 2011

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Medicaid and the Media: Sharing Stories for Good

Friday, July 29th, 2011

The past few months have been rife with intense debate over our nation’s budget and the debt ceiling. Predictably, entitlement programs, especially Medicaid, have been on the chopping block in these conversations. While legislators were proposing plans that would put the health of children, people living with disabilities, and seniors at risk, advocates across the country have organized to send a clear message: Medicaid matters.

Advocates have sent this message and garnered vital media attention by holding events, writing letters to the editor and op-eds, contacting their representatives, and most importantly, sharing the stories of the people in their communities whose lives would be at stake without Medicaid. Here are just a few success stories of advocates achieving positive media coverage for Medicaid:

  • – Highlighting stories of people whose lives have been improved by Medicaid: Health Care for All Massachusetts recently held a rally outside of Senator Scott Brown’s Boston office. Medicaid recipients provided moving testimonials about how the program has supported their families during difficult times and has helped them live independent lives. They urged Senator Brown to put his constituents above party politics and to stand up for Medicaid.
  • – Finding a creative news hook: After Paul Ryan was spotted sipping a $350 bottle of wine, Citizen Action of Wisconsin capitalized on the news coverage to highlight his hypocrisy. They held an impromptu wine tasting outside of Ryan’s office in Racine, WI to protest the contrast of the massive cuts to Medicaid and Medicare in his plan and the lavishness of his personal spending. Their efforts gained national attention when it was the center-piece of a Mother Jones blog post .
  • – Partnering with and featuring the voices of other stakeholders: Rhode Island KIDS COUNT shared their research with Dr. Maggie Kozel, a Rhode Island pediatrician, adding statistical weight to her personal experiences with Medicaid and CHIP. In an opinion piece on Huffington Post, Dr. Kozel argued that cuts to Medicaid are a misguided and alarming attempt to cut the budget and would result in harm to children and no savings.
  • – Writing op-eds: Sara Gagne-Holmes from Maine Equal Justice Center thanked the state’s delegation for promising to protect Medicaid in an op-ed to the Bangor Daily News. She reminded Mainers that their federal delegation would need continued support in their efforts to defend vulnerable people reliant on Medicaid to live independent, healthy lives.
  • – Encouraging legislators to step up their support for Medicaid: Many elected officials have stood up for Medicaid, knowing how much the program improves life for many of their constituents. Maryland Citizen’s Health Initiative approached Chris VanHollen about writing an op-ed in support of Medicaid. His strong piece was published the Baltimore Sun.

The above are robust examples of interacting with media to share how vital Medicaid is to the health and prosperity of our communities. As the budget frenzy reaches its height, there is still more work to do to keep this message at the forefront and protect Medicaid and the health of children, people with disabilities and seniors who need long-term care.

– Christine Lindberg, communications associate

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Posted in Medicaid | 1 Comment »

The ACA – Working for Women

Friday, July 22nd, 2011

Women could start seeing some big advancements in preventive care services as part of the Affordable Care Act if the recommendations from Tuesday’s Institute of Medicine (IOM) report, Clinical Preventive Services for Women: Closing the Gaps, are accepted by the Department of Health and Human Services (HHS).

The IOM report makes eight recommendations about what preventive services for women should be included under health insurance plans without requiring a co-payment. The report is a step in the right direction to ensure that women get the kind of care they need, without facing prohibitive costs.

The eight recommendations for preventive services for women are:

  • – Full range of contraceptive services and contraceptive counseling
  • – Annual well-woman exam
  • – Screening of pregnant women for gestational diabetes
  • – Annual counseling on sexually-transmitted infections for all sexually-active women
  • – Counseling and screening for HIV infection on an annual basis for sexually-active women
  • – Screening and counseling for interpersonal and domestic violence.
  • – Comprehensive lactation support and counseling and costs of renting breastfeeding equipment
  • – Addition of high-risk human papillomavirus DNA testing

To be clear, these services are not provided “free” as the media has reported. They are still paid for through insurance premiums, but they would be offered without requiring a co-payment.

HHS will decide whether to accept IOM’s recommendations possibly as soon as August 1st. The IOM report is a historic step for women’s health and shows the promise of the Affordable Care Act and what it can do for women and families. We hope HHS will swiftly approve these recommendations and not let this latest important advancement of the ACA get bogged down in politics.

You can learn more at Raising Women’s Voices: Women’s Health Preventive Health Coverage: Implementation Central.

– Reena Singh, Associate Director of State Consumer Health Advocacy

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Posted in Affordable Care Act implementation | 1 Comment »

OIG report shows only 5 States protected from drug pricing fraud

Thursday, July 21st, 2011

An OIG report issued Monday found that only a few state Medicaid programs have made plans to replace a widely-used but fraud-ridden pricing system for pharmacy reimbursement that will be discontinued this coming September in response to a consumer lawsuit by members of the Prescription Access Litigation (PAL) coalition.

The price that a health plan pays for a prescription filled at a pharmacy is based on a list price provided by drug manufacturers. However, despite being called the ‘Average Wholesale Price’ or AWP, these prices are neither average nor wholesale. They are pure fiction. But unlike a consumer haggling over a fictitious sticker price on a new car, health plans and Medicaid programs cannot haggle over the 20,000 prices for the different doses and sizes of drugs that are prescribed.

In response, a few states are pioneering some innovative new policies designed to pay something closer to the actual cost of the drug paid by the pharmacy, and CMS is looking into how to help with this process by sharing the results of a nationwide survey of pharmacy costs and drug prices.

But the OIG report warns that many state Medicaid programs need to make some quick decisions before First DataBank stops publishing AWP prices in Sept 2011.

Bottom line:

  • – 3 State Medicaid programs plan to switch to Average Acquisition Cost (AAC), a price that is calculated and adjusted based on average actual costs paid by randomly audited pharmacies to manufacturer or wholesalers. These states would follow the model of Alabama, which pioneered this new pricing system last September, followed closely by Oregon this past January. Idaho is next on deck.
  • – 20 states have not developed plans as of the February 2011 interview by OIG
  • – 10 states plan to continue using AWP price listings
  • – 12 states plan to switch to [the equally vulnerable and fictitious] wholesale acquisition cost (WAC) benchmark, which “like AWP, is not based on actual sales transactions.”

Importantly, 44 of 51 States (including D.C.) wanted CMS to establish a single national benchmark for pharmacy reimbursement. And CMS has started to work toward this, awarding a contract to launch a nationwide survey of pharmacy drug costs last week, and announcing plans to compare state approaches to paying pharmacies.

Why should a state adopt a new policy on drug prices?

The report notes that the AWP benchmark not only “fails to account for prompt pay or other discounts, rebates, and reductions” but that “as a basis for drug reimbursement” AWP “is fundamentally flawed.”

And the history of private and public sector litigation and OIG investigations show how pricing fraud under the AWP price benchmark has cost our health care system billions of dollars over the last decade. Class action lawsuits by PAL coalition members have exposed the highly fraudulent nature of industry reported prices like AWP. One lawsuit revealed that more than 28 drug makers had fraudulently inflated the AWP for many drugs that doctors purchase directly and administer in their offices. In this scheme, doctors purchased the drug for significantly less than they received from Medicare in reimbursement, which also incentivized doctors to prescribe the drugs most profitable to them.

And the PAL-member lawsuit filed against the drug wholesaler McKesson Corporation and the publishers First DataBank and MediSpan exposed how these defendants had colluded to inflate the benchmark price for hundreds of drugs starting in July of 2001, costing consumers and health plans $7 billion by mid-2005. McKesson settled the litigation by the private sector for $350 million, and later settled with the State of Connecticut for $15 million. Claims by the federal government and the rest of the states are still pending.

The Report by OIG and the lessons learned from private litigation on behalf of consumers show that drug pricing policies must be better designed to protect public and private sector health plans from fraud. At a minimum, the Average Acquisition Cost (AAC) models by Oregon, Alabama, and Idaho are a good start.

– Wells Wilkinson, Director Prescription Access Litigation

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The Insider: The Choices We Make

Wednesday, July 20th, 2011

The current political debate in Washington suffers from a narrowing of the political space that is considered “serious.” The problem extends well beyond the relative importance and urgency of reducing the national debt and addressing the persistently high unemployment rate (with the former all but eclipsing the latter). It also affects the acceptable outlines of a debt ceiling deal—with prominent moderate Senate Budget Chair Kent Conrad ‘s proposal for an equal split between cuts and revenue increases deemed a non-starter.

As we look at the ideas to reduce federal health spending, we see the same phenomenon. First, we see a total failure to look beyond direct federal spending to take into account the important contribution rising private sector health spending growth and the deteriorating underlying health of the U.S. population make to growth of federal health spending. (High unemployment also plays a role, but let’s not even go there.) Second, we see a very constricted range of “acceptable strategies” to reduce federal health spending.

On the Republican side, Congressmen Boehner and Cantor have proposed about $350 billion in health care cuts with over one-third coming in the form of cost-shifting to states and Medicare and Medicaid beneficiaries. In addition to direct cuts to state Medicaid programs, proposed increases in Medicare cost-sharing would also raise costs to states, since Medicaid picks up where Medicare leaves off for low-income seniors and people with disabilities.

What is the Democratic response? Most Congressional Democrats have voiced their opposition to radical proposals to restructure Medicare and Medicaid, but resistance to cost shifting onto states (and indirectly onto Medicaid beneficiaries) seems more muted.

A better way is possible

Meanwhile, alternative health policies that could reduce the deficit by a similar amount without harming beneficiaries have been pushed off the table or, at best, onto the fringes of the debate. We offer here a brief list of progressive health care deficit reduction measures – not so much because these ideas are politically viable at the moment, but to clarify that the damaging and dangerous policies that policymakers are now pursuing in Washington stem from the choices of political leaders.

Better cost containment agenda:

  • – Require a drug rebate for low-income Medicare beneficiaries: (somewhat on the table in the talks). When Medicare Part D was created, pharmaceutical companies received a windfall – the elimination of the requirement to pay rebates on drugs prescribed for Medicare beneficiaries who had previously had their drugs covered by Medicaid. Requiring the drug companies to pay the Medicaid rebate for low income Medicare and Medicaid dual eligibles would yield an estimated $112 billion according to CBO.
  • – Quality care pricing in Medicare and Medicaid: Although the ACA takes some small steps in this direction, more could be done to reduce low-quality health care in Medicare and Medicaid, such as potentially avoidable hospital readmissions and complications, and to promote efficiency in the system. After reviewing the literature, Community Catalyst has estimated over $100 billion in savings are available over the next 10 years from payment reforms that would target wasteful or harmful spending.
  • – Public option: The idea of having a public insurer compete with private insurers in the Health Insurance Exchanges enjoyed public support throughout the ACA debate. It also surfaced in the Bowles-Simpson debt reduction talks. (Though unlike other ideas less objectionable to special interests it has not gained traction in the political debate.) The CBO estimated ten-year savings of nearly $90 billion.
  • – Tax on sugar-sweetened beverages: The nation is suffering from an epidemic of childhood obesity, leading to increased rates of Type II diabetes in children (the kind that used to be called “adult onset” diabetes). A penny-per-ounce tax on sugar sweetened beverages would yield $79 billion over five years according to a recent analysis. To be conservative, cut that amount in half over a second five years and you still get deficit reduction of $120 billion over 10 years, while helping to improve the underlying health of the population and reducing future health care costs.

And there you have easily over $350 billion in available federal health care savings that can be achieved by weeding out low-value spending and improving public health without shifting costs onto Medicare and Medicaid beneficiaries or state Medicaid programs. Not only that, but there is no doubt that this agenda would be much more attractive to the American people than the one that is currently being pursued. Yet with few exceptions, these ideas languish on the political margins while federal cost-shifting onto states and harmful and unpopular cuts to Medicare and Medicaid beneficiaries are given serious consideration. Fortunately, people are becoming increasingly vocal in their support for maintaining public health insurance programs.

We can only hope that political leaders will start listening.

– Michael Miller, Policy Director

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Posted in care coordination/quality, Health Reform Insider | 2 Comments »

Paving the Way for New Models of Care

Thursday, July 14th, 2011

Providing insurance to low-income populations, as Medicaid does, improves their overall health and helps maintain financial stability. A new study by the National Bureau of Economic Research, says that Medicaid recipients, on average, were more likely to seek preventative services, be healthier and overall feel better than people without insurance.

Of course, there are ways to improve care especially for people with complex conditions. A new initiative in New Jersey provides a great example: policymakers, advocates, and consumers are hoping new legislation will lead the way to deliver quality care and save costs. The Medicaid ACO Demonstration Project nearly unanimously passed in the NJ Legislature in June and awaits Governor Chris Christie’s signature. This legislation would authorize the Department of Human Services to create a three-year Medicaid ACO (Accountable Care Organization) Demonstration Project where community-based, non-profit coalitions can apply for recognition by the State of New Jersey as a Medicaid ACO. The Medicaid ACO Demonstration Project intends to:

  1. Increase access to primary, behavioral and dental care, in specific regions where Medicaid recipients reside
  2. Improve health outcomes and quality by measuring patient experience
  3. Reduce unnecessary and inefficient care without interfering with patients’ access to their health care providers or the providers’ access to existing Medicaid reimbursement systems.

One of the poorest cities in New Jersey, Camden, led the way to create a system to improve the delivery of care to the sickest and poorest population, while lowering costs. The innovative care delivery system in Camden is led by Dr. Jeffrey Brenner and the Camden Coalition of Healthcare Providers. The critical issue in Camden and cities across New Jersey is to reduce readmissions to hospitals and better address the needs of the Medicaid population.

Atul Gwande highlighted the work in Camden in his “The Hotspotters” article in the New Yorker, and groundwork has been set for two similar citywide healthcare coalitions in Trenton and Newark, as well. And now New Jersey has legislation that will hopefully spread this new model of care across the Garden State.

Another great example of innovative care is the Boston-based Commonwealth Care Alliance (CCA). CCA has created a comprehensive system of care that not only improves their members’ health, but also has been proven to lower costs by keeping people out of the hospital and out of nursing homes. The organization has created a system of care and support for the neediest population on Medicare, Medicaid or so-called “dual eligibles” who receive support from both programs.

At a time when states are facing severe budget deficits, states need to explore options within Medicaid to help sustain state budgets while creating an efficient and coordinated system of care for patients. Community Catalyst has highlighted alternatives for states:

We know that Medicaid matters. If we can curb cost by addressing the needs of the high utilizers of Medicaid by coordinating better care, we can create a system that works for everyone. Massachusetts has shown us through the work of CCA, and now New Jersey is paving the way for their Medicaid population.

– Leena Sharma, Field Coordinator

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Help Shape Health Equity Work

Wednesday, July 13th, 2011

Consumer advocates have a new opportunity to influence regional work to strengthen health equity. This is your chance to make a difference!

The Office of Minority Health in the federal Department of Health and Human Services is seeking nominations for 10 regional health equity councils – one in each of the 10 HHS regions. The councils are being established to help shape and spur action on the National Stakeholder Strategy for Achieving Health Equity, which was released in April by the federal government. The strategy contains lots of good ideas for community engagement, but no new government funding. A strong council could help push the work forward, and facilitate fund-raising. Each council will contain up to 35 members from the public and private sectors. Let’s ensure that consumer and community voices are heard.

OMH is accepting nominations through midnight on July 18 at RHECnomination@minorityhealth.hhs.gov. Qualifications needed include leadership skill and experience working on health disparities. At a minimum, nominations must include the name, title, address, phone and email for both the nominee and the nominator. For more information, refer to the full description from HHS.

– Alice Dembner, Deputy Policy Director

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Posted in Affordable Care Act implementation, Health disparities | No Comments »

The Insider: Where Health Care Stands in the Debt Ceiling Negotiations

Tuesday, July 12th, 2011

This weekend Speaker Boehner rejected President Obama’s call for a “grand bargain” that would include both cuts to Medicare and Medicaid (and Social Security) along with tax increases to reduce the projected federal debt by about $4 trillion. Instead, Mr. Boehner seems to be indicating that there are not enough votes in the Republican caucus for a deal that includes tax increases – any deal should only include cuts.

You may ask yourself, well, how did I get here?
Back in April, along with a spirited defense of the role for government in the economy, the President laid out a comprehensive approach to debt reduction. The deal he outlined included cuts in military spending, and tax increases. It also included a fix for the Medicare physician payment formula to end the annual ritual of finding funding for a temporary rate patch. Although one can question whether it is either fair or logical to use cuts in Medicaid to partially pay for an increase in Medicare physician payments, as the administration proposed, at least there was some overall balance to the approach. The concern is that as the negotiations continue, the same scope of Medicare and Medicaid cuts would remain on the table without the other elements of the deal.

Equally concerning is the composition of the proposed cuts. Although definitive information about the negotiations is hard to come by, the health care proposals identified in the media are mostly a combination of missed opportunities and bad ideas.

Let’s take a look at each category:

Missed Opportunities

Graduate Medical Education
One proposal on the table is to reduce federal funding for graduate medical education. Instead of focusing on reducing GME funding, a better approach would be to make better use of existing funding by redirecting funding to increase the supply of primary care physicians as outlined here.

Medicare Bad Debt
Another proposal is to eliminate funding for Medicare bad debt. This is another missed opportunity. A reduction in bad debt should contain an explicit exclusion that free care given pursuant to a financial assistance policy would still be reimbursed, giving hospitals an incentive to actually qualify people for financial assistance. This would not only help Medicare beneficiaries, but also low-income underinsured people who often have a hard time obtaining financial assistance.

Bad ideas

The main bad ideas on the table are variations on the theme of shifting costs onto Medicare and Medicaid beneficiaries, including blended rate (combining regular federal Medicaid match, CHIP match and enhanced match for new eligibles under the ACA into a single rate); eliminating or curtailing states’ use of provider taxes; and increases in Medicare cost sharing, all of which will shift costs onto state Medicaid programs and result in cuts in rates or benefits.

A better way
In a plan presented to the Senate Democratic caucus, Budget Chair Kent Conrad outlined a better approach that relies more on progressive taxes and less on health care cuts.

Nor does Conrad’s proposal exhaust the opportunities. In a future post we will look at some of the policy options that could generate federal health care savings that improve quality, efficiency and the underlying health of the public without hurting Medicare and Medicaid beneficiaries.

– Michael Miller, Policy Director

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Pew report: The clock is running on another Heparin

Tuesday, July 12th, 2011

This blog was originally posted on PostScript.

The shipment of your birthday present from distribution to delivery can be tracked. A sticker in the grocery store tells you where your pineapple was grown. A tag in your t-shirt says where it was made. Your new car lists where its component parts are from, and where it was assembled. But if you rely on anything from Tylenol to cancer treatment, you have less information about where those drugs came from and what path they took to get to you.

That’s just one startling fact in a new report released today by the Pew Health Group. After Heparin: Protecting Consumers from the Risks of Substandard and Counterfeit Drugs echoes the FDA’s recent call to overhaul the system that monitors imported drugs, and puts forward a number of recommendations to close those safety gaps.After_heparin White paper

“Consumers should be alarmed by the increasingly complex, globalized, and outsourced drug supply chain described in the After Heparin white paper,” Robert Restuccia of Community Catalyst said in a statement. Community Catalyst has teamed with Pew to advocate for many of the recommendations in the report, and leads the broad-based Alliance for a Safe Drug Supply.

“After Heparin shows that outsourcing is growing and is a business strategy for all types of prescription and over-the-counter drug producers,” he said. “As one major brand-name drug maker put it: ‘If we can buy it cheaper than we can make it then of course that’s what we’re going to do.’

And indeed, the numbers bear that out. When it comes to drugs, the U.S. import deficit on pharmaceuticals grew to $18 billion in 2008, and it is estimated that 80 percent of pharmaceutical ingredients and 40 percent of all finished drugs in the U.S. now come from overseas.

As we’ve written about here in recent weeks and months, there’s been surprisingly broad consensus from industry, regulators and the public that the system in place to monitor these imports is broken down and in urgent need of fixing. Last year, 94 percent of pharmaceutical executives surveyed said using foreign-made raw materials was risky. And in a different poll, the same percentage of likely voters wanted FDA to be able to recall unsafe or adulterated drugs, as it can for food. Only Congress can give the agency that power.

At the Pew After Heparin conference in Washington D.C. in March, which informed today’s report, we heard that everyone should be inspected by somebody—and that companies should be fully accountable for checking out factories and quality conditions prior to contracting with a supplier. We heard that in this fractured supply chain, industry actors needs to work with each other and with regulators to share information they may receive on potentially dangerous or counterfeited drugs, and that a uniform tracking system to help verify a drug’s path from factory to pharmacy is sorely needed, but will most likely require the force of law to achieve.

Recently, we talked with pharmaceutical expert Prabir Basu about the importance of investing in good manufacturing science – both on the design side, and ensuring that the tests used to detect false or substandard medications are state of the art.

We talked with California Board of Pharmacy Director Virginia Herold, who illustrated the importance of having a national tracking system for drugs that enter our homes and hospitals.

We heard from API manufacturer Brant Zell, who said the FDA has had its hands tied for years when it comes to fulfilling its mission to ensure the safety of foreign-made drugs. Zell said he thought that the heparin crisis in 2008 would be the straw that broke the camel’s back, and moved Congress to act. To date, that’s not been the case.

We’ve seen the FDA go before Congress to ask for the authorities and tools to do a better job of ensuring the quality and safety of drugs before they get to U.S. shores, and keeping ones that don’t meet quality standards out and off the shelves. So far, Congress has yet to act on those requests.

At a hearing last week, some in Congress again pledged to take action and pass a law that would guide the building of these industry quality rules and give the FDA the authorities it needs to oversee a terribly complex and global supply chain. Today’s report reminds us that there are enough gaps in the supply chain to exploit and economic incentives to do so that the clock is surely running on another heparin-like crisis. The time to act is now.

You can read the full report or watch a webcast of the March conference here.

–Kate Petersen, PostScript blogger

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Setting the Record Straight on Medicaid

Friday, July 8th, 2011

Earlier today, Community Catalyst joined 118 groups representing consumers, people of faith, and health care providers in 34 states to raise our collective voices in support of Medicaid.

Together, we sent a response to the letter that Senator Hatch and Congressman Upton wrote to Governors last month. Their letter attacked Medicaid, falsely claiming that it provides poor quality care, lamenting its enrollment growth over the past decade, and blaming it for federal and state budget crises. Our letter sets the record straight:

• Medicaid provides high-quality care that is uniquely suited to meet the needs of the vulnerable Americans it serves. Medicaid is certainly not perfect, and there is always room to improve care. But studies consistently show that Medicaid beneficiaries get care that is equal to – and sometimes better than – the care they would get in private coverage. Just yesterday a new study was released documenting the positive impact Medicaid has on its vulnerable beneficiaries’ health and financial security.

• Medicaid plays an essential role in reducing the number of uninsured. Of the 46 million low-income children and parents that rely on Medicaid, the majority are in working families without access to private coverage. Policies that scale back on Medicaid eligibility for this population – like those promoted by Senator Hatch – would drive up the ranks of the uninsured, leaving vulnerable Americans without access to the health care they need.

• Medicaid is markedly more cost-effective than private coverage. If the low-income children and parents on Medicaid were insured instead on the private market, national health care expenditures would be significantly higher.

We felt particularly compelled to respond because Hatch and Upton’s letter perpetuates a larger anti-Medicaid narrative that would:

• Reduce the deficit on the backs of those with least political clout. Responding to their mandate from the tea-party, Republican Congressional leaders are insisting on trillions of dollars in spending cuts in exchange for their votes to lift the debt-ceiling (a vote Congress must take in early August to avoid going into default on our nation’s debt). It’s nearly impossible to achieve that level of savings without making devastating cuts in the “big three” entitlements that take up 40 percent of the federal budget: Social Security, Medicare, and Medicaid. But Social Security and Medicare are fiercely guarded by a well-organized political constituency – seniors – which makes cuts in those programs politically unpalatable. That leaves Medicaid, which serves a much more vulnerable and less politically empowered population, as the sacrificial lamb.

• Undermine the Affordable Care Act. The attacks against Medicaid also play into a second tea-party-driven agenda to repeal the Affordable Care Act (ACA.) Since Congressional Republicans don’t have the votes for repeal, they’re trying the next-best approach: weakening the law’s foundations. Medicaid accounts for nearly half of the coverage gains expected under national health reform, so inflicting dramatic cuts on the program would jeopardize the ACA before its even been implemented.

But Medicaid is not a political chit. It’s a lifeline for millions. It provides long-term care to our nations’ seniors, enables people with disabilities to get the care they need to live independently and helps low-income children see the doctor when they’re sick.

The 118 consumer, faith-based and provider organizations from across the country who signed onto our letter know the value of Medicaid in their communities and why it’s worth protecting. And polls show that the overwhelming majority of the American public does too. Is Congress listening?

-Katherine Howitt, Policy Analyst

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Guess what? Medicaid Matters

Thursday, July 7th, 2011

A new study today, the most robust of its kind in 40 years, concludes that Medicaid makes a big difference for its enrollees. The study, authored by the National Bureau of Economic Research, documented that Medicaid recipients, on average, were more likely to have a usual doctor, obtain preventative services, and overall, were healthier and felt better.

For advocates, this is no surprise.

The study, based on patients in Oregon, is unique. Because of limited funds in Oregon, the state allocated Medicaid slots through a lottery, enrolling 10,000 of its 90,000 applicants. This allowed researchers to ethically measure the effect of people who enrolled in Medicaid against those who did not. This randomized trial is the gold standard for research studies.

There were also other benefits to having Medicaid. The study found that people with Medicaid were less likely, on average, to have medical debt. Medicaid offers Americans both financial and health security.

The study results are a firm rebuttal to Medicaid critics who claim that vulnerable patients would fare better by relying on charity care and emergency rooms than insurance. As the lead author MIT economist Amy Finkelstein notes: “The bottom line is that Medicaid really matters in people’s lives…There is a large concern out there about whether Medicaid actually makes a difference, and now we actually have evidence.”

— Eva Marie Stahl, Policy Analyst

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