Among the many Americans who find Medicaid confusing is Robert F. Kennedy junior, whose department oversees it. At his confirmation hearing last month he estimated the programme insures 30m babies (the number is closer to 1.5m), that Medicaid premiums and deductibles are too high (Medicaid recipients typically do not pay either) and that recipients are unhappy (89% say they are satisfied).
Just over a fifth of Americans are now insured under Medicaid. Mr Kennedy contrasts its rising cost with Americans’ ailing health. “Everybody here says Medicaid is sacrosanct,” he said. But “nobody’s admitted that Medicaid is not producing positive health outcomes.” Is he right?
Studying the effect of Medicaid is hard. For ethical reasons researchers cannot usually use randomised control trials. And the health benefits that insurance schemes might offer accrue over the course of a lifetime. Critics of Medicaid often point to a rigorous, influential study from Oregon published in 2010. This experiment studied a 2008 lottery for access to the state’s then-limited Medicaid expansion.
While depression and subjective health measures improved among the 6,000 Oregon lottery winners, objective measures like hypertension and cholesterol didn’t budge. Donald Trump’s former head of Medicaid wrote in 2017 that the Oregon study and others called “into question” the “effectiveness” of the programme. But the 6,000 sample size was too small to measure the effect on diseases like cancer and may have prohibited other statistically significant findings.
“Everybody took what they wanted from the experiment,” says Heidi Allen, one of the study’s lead investigators. Katherine Baicker, another lead researcher in the Oregon experiment, notes that “both the black and white pictures of the programme are not supported by the study.” Medicaid is not a silver bullet. But it is better than being uninsured. Subsequent studies on Medicaid and mortality rates provide “really compelling evidence that if it is substantially cut we should expect to see some people die”, says Ms Allen. ■
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