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Oregon study raises some questions about expansion of Medicaid program

Oregon study raises some questions about expansion of Medicaid program

Idaho Freedom Foundation staff
May 8, 2013
[post_thumbnail]Rep. Tom Loertscher, R-Iona, attempted to have the Legislature consider an expansion of Medicaid.

Near the completion of the Idaho legislative session in late March, consideration arose about the possibility of expanding Medicaid. But a newly released report from the New England Journal of Medicine (NEJM) about the expansion of Medicaid, and the consumption of public health services, may cause policymakers and other stakeholders in Idaho to re-think some of their assumptions.

“I’m aware that there is a new report from the journal, but I have not familiarized myself with it and cannot comment on it,” said Susie Pouliot, chief executive officer of the Idaho Medical Association. Pouliot served on Gov. Butch Otter’s Medicaid Expansion Task Force, an advisory board that unanimously recommended to Otter in March that the state expand Medicaid.

The NEJM story suggests that the actual expansion of a state’s Medicaid coverage plan doesn’t necessarily produce its intended results. The research comes from a Medicaid expansion plan implemented in Oregon in 2008, a plan wherein participation was based on lottery drawings from a waiting list. The findings were based on two years’ worth of data.

The study from Oregon’s Medicaid expansion suggests that people on Medicaid received more preventive care, including mammograms, flu shots and Pap smears, but the preventative care did not necessarily lead to faster and cheaper treatment of their ailments.

Preventative care seemed to only save money in cases where the early diagnosis of health problems outweighed the cost of all the doctor visits and screening tests performed on people who are well and don’t need treatment.

Further, some screening tests among Oregon’s Medicaid consumers, particularly those tests intended to catch certain cancers early, actually led to unnecessary harm and false positive tests.

Other findings from the Oregon study suggest that when patients have access to taxpayer-funded health care services they consume more of them; that the quality of the health care that the Medicaid patients received was not necessarily better than what they might have received elsewhere; and that the lack of available health care services is not the only factor that inhibits a person’s health status. That is, other non-medical considerations, such as lack of education and employment and healthy food, can also diminish a person’s well-being.

The Oregon study did suggest that the expansion of Medicaid brought about a reduction in incidents of depression, but did not seem to reduce the rates of high blood pressure and high cholesterol cases.

Begun in 1965, the Medicaid program provides certain health care services to individuals and families with low incomes and limited resources. A key component of President Barack Obama’s Affordable Care Act (Obamacare) was to have mandated that the individual states reduce eligibility requirements for Medicaid and expand the number of participants in their respective programs. However, the United States Supreme Court overturned that component of the Obamacare law, so expansion of Medicaid is now treated as an elective choice for each of the states.

Last summer, Otter appointed a task force to study the possibility of Medicaid expansion in Idaho. In January of this year Otter spoke of Medicaid in his State of the State address, but noted that he was not seeking a Medicaid expansion this year.

However in March, Rep. Tom Loertscher, R-Iona, proposed legislation that would have scuttled Idaho’s state catastrophic care (CAT) fund system, which is a program that provides health care services for persons in dire circumstances. It is funded with both state tax revenues and local property taxes. His proposal would have shifted patients who consume the CAT care services to an expanded Medicaid program.

Loertscher surmised that because the federal government is promising to reimburse the states for their first two years of Medicaid expansion costs, Idaho could save several millions of dollars in state revenues by acting on the Obama administration’s offer now.

“If we’re going to expand Medicaid, this would be an ideal year to do it,” Loertscher told the House Health and Welfare Committee at that time. However, his plan never made it out of the Legislature.

Pouliot and the other task force members agreed with Loertscher. On March 18, the task force met and discussed how the preventative care and chronic care services of Medicaid would improve public health care services in the state, as opposed to Idaho’s current approach with catastrophic care for the poor and indigent.

“Preventative care and chronic care is a better way to approach these things, rather than letting people’s health problems exacerbate to the point that they show up in the emergency room,” Pouliot told to IdahoReporter.com Tuesday. “Idaho committed to providing these services many years ago. It makes sense that we would do it in a way that costs Idaho taxpayers less and improves health care services.”

The NEJM research was published May 1. While the possibility of Idaho expanding Medicaid is on hold for now, it is anticipated it will be pursued in the 2014 legislative session.

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