July 7, 2011 | Posted By Bruce D. White, DO, JD

An NPR story this morning caught my attention. The Julie Royner report title is “Medicaid Makes ‘Big Difference’ in Lives, Study Finds.” It is available online by clicking here.

A new Harvard-National Bureau of Economic Research-State of Oregon project shows that Medicaid patients are happier with Medicaid coverage than they are when they are uninsured. But this wasn’t the principal point of the story. The report began with the notion that Medicaid patients themselves are not happy with their Medicaid coverage. Medicaid patients say they can’t find doctors who accept Medicaid patients, that the services they do receive when compared with those that have regular insurance are not as good, and there are strict limits on the services available. Moreover, politicians are not happy with Medicaid because the costs keep going up – taking a larger slice of the revenue pie – and it’s a very difficult program to manage.

Ms. Royer seemed surprised with the study findings because it contrasted so sharply with the commonly held view of the past 40 years that the Medicaid program didn’t really help patients as originally intended and it was for the most part a failure.

To me the study results aren’t that startling. Nor is there a irreconcilable contrast between what Medicaid patients and politicians think.

1. Medicaid patients are happier to have Medicaid coverage as opposed to no coverage at all. Medicaid allows access – albeit sometimes hard to find – when uninsured patients have none?Moreover, in an emergency, Medicaid patients who go to the hospital won’t be worried – or maybe even hounded – about paying the hospital bill?

2. For the overwhelming majority of Medicaid patients, the Medicaid program meets their health care needs adequately at relatively low cost. See the 2006 Kaiser Commission on Medicaid and the Uninsured’s Report “Medicaid’s High Cost Enrollees” here. Roughly 4% of the Medicaid enrollees require more than $25,000 per year in health care costs. These 4% account for 49% of Medicaid expenditures. These are often the “sickest of the sick” under age 65, the disabled children and adults, and the elderly who reside in nursing homes. When one drills the statistics down even more, the costs for providing health care to well children in poor families – the group that Medicaid without question should cover – are less than $1,500 per year per child. One might think that a researcher is far more likely to ask a family member whose health care needs are adequately met by the Medicaid program – and might be happier with Medicaid coverage – rather than one of the 4% whose needs are so great that vast expenditures are required.

The randomly controlled study – perhaps the first of its kind – would not have been possible except for the way that the State of Oregon offered Medicaid coverage to its pool of qualified citizens by lot. Some Oregonians were eligible just because their number came up, others didn’t get Medicaid coverage because there simply wasn’t enough money budgeted to cover everyone. Again, the study results seem to make sense. People who win a lottery are usually happier than the ones who don’t. I wonder if there will come a time when the “sickest of the sick” under age 65, the disabled children and adults, and the elderly who reside in nursing homes will be randomly selected by lot to determine who qualifies for Medicaid and who doesn’t?

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.


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