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.”
Continue reading Health Policy Updates: July 8 2017
This week Republicans made some amendments to the AHCA before continuing it along its legislative course to passage. Including work requirements for Medicaid recipients and large tax cuts for high-income Americans, these changes seem oriented more towards placating hard-Right opponents such as the Freedom Caucus rather than fixing the many problems with the bill that health policy wonks – both left and right – have been pointing out.
“These aren’t changes that address the core problems the GOP health care bill will create for voters, insurers, or states; instead, it’s legislation that tries to solve some of the problems the bill creates for conservative legislators….None of these provisions meaningfully change the underlying legislation, nor any of its flaws. These are mostly tweaks meant to win over hardcore conservatives and Congress members from New York.”
Ultimately, however, these efforts were not effective in winning enough support among Republican members of Congress. Rather than see the bill go down in defeat, Speaker Ryan pulled the bill from the House floor on Friday before any vote took place. The consensus is that this means efforts to repeal the ACA *currently* dead.
“Then, the Friday vote was abruptly canceled, as Republicans failed to whip enough votes for the bill. And so, Ryan concluded, Obamacare remains the law of the land.”
Continue reading Health Policy Updates: March 25 2017
The big news of the week was the Congressional Budget Office’s (CBO) appraisal of the Republican health care plan, the AHCA. There has been some controversy because the CBO’s predicted that 24 million Americans would lose health insurance, a number higher than even the bill’s vocal critics had been predicting. Many major news outlets, politicians, and pundits have weighed in.
The New York Times:
“The much-anticipated judgment by Capitol Hill’s official scorekeeper did not back up President Trump’s promise of providing health care for everyone and was likely to fuel the concerns of moderate Republicans. Next year, it said, the number of uninsured Americans would be 14 million higher than expected under current law.”
The Washington Post:
“The report predicted that premiums would be 15 percent to 20 percent higher in the first year compared with those under the Affordable Care Act but 10 percent lower on average after 2026. By and large, older Americans would pay “substantially” more and younger Americans less.”
One interesting reaction was that of House Speaker Paul Ryan, who tweeted out that the CBO report will “improve access to quality, affordable care.” This has led to criticism as well as incredulity, as a loss of insurance for 24 million Americans can hardly be interpreted as “improved access”.
Continue reading Health Policy Updates: March 18 2017
A large part of the ACA/Obamacare was to expand Medicaid; many (though not all) states elected to do so. New data out this week in JAMA Internal Medicine suggests that patients are benefiting. Compared to states that did not expand Medicaid, previously uninsured patients who have now gained access to Medicaid coverage do better on many metrics, including better access to outpatient care, increased diabetes screening, and reduced non-compliance due to cost.
The Oregon Medicaid experiment from a few years ago left Medicaid skeptics with some reason to be agnostic as to whether Medicaid actually improves people’s health. These data lessen the foundation for such skepticism, and should thus should help move the conversation forward. Continue reading Health Policy Updates: August 14 2016
Last year, the news-worthy story was that “thousands of women with ovarian cancer are not getting a proven, life-saving treatment.” That treatment, intraperitoneal (IP) chemotherapy had some clinical trials showing that it was much more effective than conventional chemotherapy. The kerfuffle was over the fact that IP chemo was not getting incorporated into medical practice, despite the evidence showing it’s benefit, and too many women were still getting traditional chemo. You can find the NYTimes report on this, here.
One year later, we are also one year wiser. Unfortunately, a newer, better study of IP chemo for ovarian cancer failed to show any benefit. It now looks like IP chemo isn’t any better than regular chemotherapy – and is a lot more grueling to endure. Sometimes, medical science is messy like this. While it is certainly bad that many people have probably gotten this treatment unnecessarily, it is science’s dedication to thorough testing and self-questioning that prevented a far worse outcome – that many thousands of future women would go on receiving IP chemo, on the false understanding that it is beneficial. Continue reading Health Policy Updates: April 9 2016