Monday, December 16, 2019

Small: Cult-like claims for Medicaid expansion

Cult-like claims for Medicaid expansion
By Jonathan Small

The arguments made by supporters of Medicaid expansion often have a quasi-religious undertone straight from the bowels of a really bad cult, not a serious policy debate. The latest example is a report that stops just short of suggesting Medicaid coverage can raise the dead.

A report by the Center on Budget and Policy Priorities, a liberal think tank, recently indicated 476 Oklahomans ages 55 to 64 who died from 2014 through 2017 would still be alive today had the state expanded Medicaid. That study was based overwhelmingly on data culled from another report on “Medicaid and mortality” published by the National Bureau of Economic Research.

Those reports are being used to silence Medicaid-expansion critics and tar them as indifferent to Oklahomans’ lives. But if you look closer at those reports, their conclusions appear more the result of wishful thinking than valid analysis.

For instance, the authors of the underlying NBER working paper concede that a limitation of their work is “that our data do not include information on the cause of death.” That’s a big caveat.

Put simply, we don’t know what killed those 476 Oklahomans, but that isn’t stopping activists from claiming Medicaid would have kept those folks alive. But people killed in car crashes or by gunfire would not be walking among the living today if only they’d Medicaid coverage. And there are many sad instances where insurance coverage does not prevent death.

The NBER paper found Medicaid increased hospitalizations, including for “visits for conditions that require immediate care”—in other words, emergency care. But people are already guaranteed treatment for emergency care under federal law. Medicaid won’t save lives by providing treatment to people who already receive that same treatment without Medicaid.

Demographic differences among states are also ignored. If people in another state were already wealthier and healthier, on average, than their Oklahoma counterparts before Medicaid expansion, then the continued existence of that gap today is not a sign Medicaid expansion improved outcomes.

Notably, Tom Adelson, a former Oklahoma Secretary of Health who supports Medicaid expansion, recently admitted in The Oklahoman that even if our state expands Medicaid, “none of us should be under the illusion that we will be altering the downward trajectory in overall outcomes, including growing differences in health outcomes based on income.”

Adelson concedes the obvious: Medicaid doesn’t change health outcomes. His conclusion is validated by the results of a truly gold-standard experimental/randomized controlled trial conducted in Oregon that observed no significant effects from Medicaid coverage on any collected health measures.

Next year, Oklahoma voters will be asked to expand Medicaid to cover 628,000 able-bodied adults at a state taxpayer cost of up $374 million annually. That decision should be made based on concrete facts, not the “magical thinking” of proponents who imply Medicaid will somehow transform the dead into the living.

Jonathan Small serves as president of the Oklahoma Council of Public Affairs.


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