Health Policy Updates: July 8 2017

One of the arguments from Republicans to support the BCRA’s steep cuts to Medicaid is that it is “bad insurance” – that having Medicaid somehow causes its beneficiaries to have WORSE health outcomes than those without insurance at all. Clearly, this is an extraordinary claim; how could having health insurance make one worse off? Is there “extraordinary evidence” to support the notion that Medicaid is harmful?

Health policy experts Austin Frakt and Aaron Carroll examine the available evidence. Moving beyond purely correlational studies (Medicaid patients are also quite poorer than average Americans, and so have many reasons to be unhealthy besides having Medicaid), it becomes clear that Medicaid does not, in fact, harm people.

“Findings from more recent studies looking at expansions in enrollment, in the 2000s and then under the Affordable Care Act in 2014, are consistent with older ones. One can argue that Medicaid can be improved upon, but the credible evidence to date is that Medicaid improves health. It is better than being uninsured.”

In addition to the straight-up cuts to Medicaid, the Senate bill would attempt to lower Medicaid enrollment through another mechanism – making it more difficult for people to sign up and stay on Medicaid. Rather than the annual eligibility assessment that Medicaid has traditionally done, the BCRA would allow states to begin requiring that beneficiaries go through the process of demonstrating eligibility every 6 months.

“Health policy researchers say there’s ample evidence that adding paperwork and administrative burdens on beneficiaries in Medicaid increases turnover, called churn. For the most part, it’s not because people are no longer eligible for the program, they say; it’s that poor people move frequently and often face a host of challenges that make them less likely to turn in required paperwork.”

If you are a podcast person – or have a free hour – I highly recommend this conversation between liberal journalist/commentator Ezra Klein and conservative health policy wonk Avik Roy.

In contrast to the typical policy debate in the political sphere – inflammatory rhetoric from people who clearly know very little about our health care system – this is a well-informed, respectful, and detailed debate. When I hear people like this discuss the issue, I am able to retain a small modicum of optimism that there is more underlying agreement between experts than we often realize, and that areas for intelligent compromise still remain when cooler heads prevail. I wish more political disagreements sounded like this podcast!

For a second podcast this week, I would recommend a recent episode of libertarian economist Russ Robert’s Econtalk. He talks with health economist Robin Feldman about her recent book Drug Wars, which explores many of the commercial and legal shenanigans that drug companies use – “evergreening” and “pay-for-delay”, etc. – to avoid patent expiration and keep their prices high.

The trouble that the BCRA is having in the Senate is that some of the GOP “holdouts” want the bill to get more conservative, and some want it to be less so. has put together a very straightforward chart illustrating just this problem, showing which Senators want what changes.

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