Learning from Oregon’s Medicaid Expansion?
With many states still considering whether or not to expand their Medicaid programs a new study published in the New England Journal of Medicine sheds some light on what health, financial, and other outcomes to expect.
In 2008, Oregon expanded its Medicaid program to 30,000 more people selected randomly from a waiting list of 90,000. The new report analyzes actual outcomes from more than 12,000 patients newly enrolled in the program and found Medicaid did not improve health outcomes for those patients. The report also found Medicaid enrollment increased the use of health care services, raised the rates of diabetes detection and management, lowered rates of depression, and reduced financial strain.
According to Phillip Klein of the Washington Examiner, “the study suggests that expanding Medicaid is one way of reducing financial pressure on low-income groups, but it’s costly and does not improve their health. Another interesting finding was that though medical spending increased among Medicaid enrollees due to more prescription drug usage and doctors’ visits, the study ‘did not find significant changes in visits to the emergency department or hospital admissions.'”
Many free-market health care experts are pointing to this as a reason to hold off on expanding Medicaid. As Heartland Research Fellow Benjamin Domenech explains, “I would rather have a smaller program that met its promise to America’s poor and the truly sick rather than a larger one that offered a false promise of access.”
For three years, an incredibly nerdy—but consequential—debate has raged among health policy researchers regarding Medicaid, America’s government-run health care program for the poor. Piles of studies have shown that people on Medicaid have health outcomes that are no better, and often worse, than those with no insurance at all. But supporters of Obamacare were cheered in 2011 when a lone study, out of Oregon, purported to show that Medicaid was better than being uninsured. Yesterday, however, the authors of the Oregon study published their updated, two-year results, finding that Medicaid “generated no significant improvement in measured physical health outcomes.” The result calls into question the $450 billion a year we spend on Medicaid, and the fact that Obamacare throws 11 million more Americans into this broken program.
For several reasons, I am especially interested in the topic of Medicaid’s poor health outcomes. For one thing, I believe that the moral legitimacy of any approach to health reform comes from whether or not it truly helps the poor, in a manner that is also respectful to the middle-income taxpayers who are struggling to pay their own bills.
Another reason is that I happen to have a lot of experience in analyzing randomized, controlled trials; it’s a big part of what professional investors do when they analyze pharmaceutical, biotechnology, and medical-device companies. Over the course of my career, I’ve looked at hundreds of these trials, in an effort to see whether or not the market was underappreciating or overhyping new therapies. So let’s break down the Oregon Medicaid study the way a professional would break down the clinical trial for a new cholesterol or diabetes drug.
Proposed legislation that would have placed a moratorium on frac sand mining in Minnesota died in the legislature in late April. In response the Land Stewardship Project expressed disappointment by telling the Winona Daily News, “We need an active role for the state government in this that goes beyond recommendations for local governments on this issue.”
In a letter published last week, Policy Analyst Taylor Smith counters by saying, “By imposing a moratorium on frac sand mining, which the LSP advocates, jobs will be destroyed and revenues will be lost to state and local governments.”
Nearly 8,000 kids are suddenly uncertain about where they will attend school this fall now that the Louisiana Supreme Court has ruled 6–1 the state’s voucher program is unconstitutional. Because the justices ruled against how the program is funded, state lawmakers can vote to fund the program directly rather than through the public school fund, making vouchers once more constitutional before fall. Gov. Bobby Jindal (R) has previously promised to call a special session of the state legislature to do just that if the state supreme court ruled this way.
Valerie Evans, a voucher mom who participated in the court case, said, “Without this program, my son Gabriel would be forced back into an unsafe school where there’s very little education occurring.”
Budget & Tax
If taxpayers and ratepayers want to avoid unaffordable utility bills and huge liabilities in the not-too-distant future, they must insist now on more competition, oversight, and innovation in the way public officials manage the nation’s water and sewer systems.
That’s the conclusion of a comprehensive study by the 362,000-member National Taxpayers Union (NTU). The analysis projects hundreds of billions of dollars in future government expenditures could be saved by adopting techniques such as open, competitive procurement for pipe materials and better asset management.
“Every time they experience the inconvenience of water main breaks or the frustration of skyrocketing utility bills, Americans sense that the water infrastructure they depend on is in serious need of reform,” said study author Gregory Baird, a renowned water finance expert. “However, simply throwing new funding into more holes in the ground, without making fundamental changes in the way infrastructure is procured and managed, won’t restore the public’s trust.”
Last week Senate Majority Leader Harry Reid successfully pushed to the Senate floor a major online tax bill originally titled the Marketplace Fairness Act, bypassing the committee process. The proposal, which passed the Senate with a vote of 69 to 24, expands the ability of state governments to force out-of-state retailers to collect sales taxes for online and mail-order sales, even if the seller has no physical presence in the state.
If the bill passes the House and is signed by President Obama, it would give states a vast new power over retailers outside their borders, including the imposition of auditing requirements. States would be allowed to create their own unique definitions of how and when items are taxed, increasing confusion for out-of-state sellers.
Proponents of the bill have recently begun an effort to sway Republican votes by distributing material outlining support of the bill from several conservative legislators and commentators. In fact, outside of a small group of conservative legislators, the majority of support for the Marketplace Fairness Act comes primarily from legislators seeking new tax revenue or interest groups using the government to undermine their competition by imposing a tax on their online competitors.
The Marketplace Fairness Act violates the key tax principle requiring a physical presence to impose a tax and is inconsistent with conservative tax values.
The Heartland Institute has compiled a list of legislators, journalists, and think tank leaders across the conservative and libertarian spectrum who strongly oppose the Marketplace Fairness Act. It is available online here.