On health care, divining the truth as we want it

02/06/2014 4:45 PM

02/08/2014 7:04 PM

Harvard researcher Kate Baicker laughed when she showed a group of Kansas lawmakers and others a collection of headlines showing how various media had interpreted her groundbreaking study on the effects of Medicaid expansion in Oregon.

“Another Obamacare glitch!” one declared.

“Oregon study shows how much coverage improves lives,” said another.

Baicker’s favorite: “How to use the Oregon study to your ideological advantage.”

This is how it goes with health care reform. Researchers lay out the data, and everybody retreats to their respective corners to repackage it.

We’re seeing that this week with the release of a Congressional Budget Office analysis projecting the Affordable Care Act will cause some people to work less, shrinking the workforce by the equivalent of 2.5 million positions. That’s not fewer jobs, mind you, but rather a drop in the number of people holding on to them.

“Death blow to Obamacare,” screeched the New York Post.

“Why the new CBO report on Obamacare is good news,” countered Los Angeles Times business columnist Michael Hiltzik.

This column is meant to be about the Oregon study, so I’ll leave it up to you to decide whether it’s a bad thing that workers are finding that affordable insurance is creating life choices.

People who could afford to retire don’t have to hang on until they reach the age of Medicare eligibility. Folks who want to be entrepreneurial can go out on their own. Parents might be able to stay home with small children. Jobs could open up for those unemployed college graduates.

So, I guess you all know where I stand on that matter. Now, back to Oregon.

In 2008, the state had funds available to expand its Medicaid rolls. But the money didn’t come close to meeting the demand, so the state held a lottery; 90,000 persons competed for 10,000 slots.

Baicker heard about the lottery and recognized a golden opportunity. By following samples of those who were chosen and those who weren’t, researchers could compare health outcomes and other factors. She secured a grant, assembled a team and went to work.

The first set of findings was rolled out in May. It showed that Medicaid eligibility did not have an effect on recipients’ blood pressure, cholesterol levels or chance of being diagnosed with diabetes. Hence the doom and gloom headlines.

But the study also showed that eligibility nearly eliminated the dire financial consequences that comes from being uninsured. And recipients showed a 30 percent lower rate of depression than those left out in the lottery. Cue the happy headlines.

More recently released findings showed that, rather than cutting costs, eligibility resulted in more hospital admissions and outpatient care. One predicted benefit — a lower use in emergency room care — didn’t materialize.

Baicker, who was invited to Topeka by the Kansas Health Institute, said her role wasn’t to recommend to states whether to expand Medicaid eligibility. Kansas and Missouri so far have opted not to.

“Beneficiaries are much better off,” Baicker said. “Medicaid has improved their well-being, and it has improved their health. Whether you think it’s the best use of your tax dollars depends on what else you could do with the money.”

Unfortunately, too many politicians in Kansas and Missouri think cutting taxes for the wealthy is a better use of money than insuring the working poor.

Should they ever change their minds, the Oregon study provides important information for legislators who are serious about improving Medicaid systems as they expand eligibility. If people are still overusing hospital emergency rooms, for instance, charge a hefty co-pay.

We could solve a good many problems if, instead of seeing data as a weapon, we used it as a tool.


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