Oregon Medicaid study fails to provide answers

Medicaid isn’t the ideal model for healthcare delivery, but it’s not a train wreck either. Industry observers continue to volley the pros and cons of a recent study that reviewed Oregon’s expanded Medicaid program over a two-year period.

The New England Journal of Medicinereported in May that Oregonians who won a 2008 lottery to be included in expanded Medicaid benefits had mixed results on health measures compared to their counterparts who did not win a place on the rolls. Authors say the effects of expanding coverage are unclear.

Those who did gain coverage improved on certain measures, such as self-reported depression, increased use of preventive measures and lessened out-of-pocket costs. Other areas showed no improvement, such as control of blood pressure, cholesterol and HbA1c levels.

“The study used a small number of measures, looking at a two-year period,” says Margaret Murray, CEO of the Association for Community Affiliated Plans (ACAP) and an MHE editorial advisor. “It is possible-and makes intuitive sense-that health status among those with Medicaid coverage would further improve over time, particularly for those with chronic illnesses.”

She says the improvement in depression is statistically significant and underscores Medicaid’s role in increased access to and use of healthcare services. Further, she says, continuous coverage for Medicaid populations moving forward would help improve not only their care but the industry’s ability to measure quality.

“If Congress were to enact legislation providing for standardized quality measurement and reporting across the entire Medicaid program, think of the comparisons we could make that we can’t today, owing to a lack of measurement or small sample sizes,” Murray says.

Currently Congress is debating the Stabilize Medicaid and CHIP Coverage Act, which would bring continuous enrollment to targeted populations.

Return on investment

As the country ramps up Medicaid expansion, policymakers will be looking for evidence of a return on their investment of taxpayers’ dollars. While the Oregon study can’t ultimately prove benefits of Medicaid coverage, it can’t disprove benefits either.

“It’s a phenomenon that will be played out over the next couple years as Medicaid expansion takes hold,” says Don Hall, principal, DeltaSigma, LLC, and an MHE editorial advisor.

Hall says Oregon has a robust safety-net system with federally qualified health centers and rural clinics that can serve patients who don’t have health coverage. Residents moving from the ranks of the uninsured to the Medicaid system basically gained a different funding system rather than dramatically improved access, he says.

“It’s a tribute to the federally qualified health centers and the rural centers that create that safety net,” he says.

However, as more Americans gain Medicaid coverage, they will have additional access to the Medicaid network of providers. Community clinics that assist the needy might see a drop in patients as they migrate to other facilities. Reduced numbers of patients can disrupt funding or in some cases cause the clinics to shut down.

The Congressional Budget Office estimates that health reform expansion of Medicaid will cost about $6,000 per patient per year.