On Wednesday, the New England Journal of Medicine published a further analysis of the Oregon Health Study, showing significant gains in financial security for Medicaid beneficiaries. Catastrophic health costs of more than 30% of annual income were nearly eliminated for those who obtained Medicaid, addressing a major cause of bankruptcy and homelessness. There were also statistically significant reductions in having medical debt, skipping payments, or borrowing to pay bills.
Press accounts have focused on the lack of statistically significant improvements in certain health indicators, particularly blood pressure, cholesterol, and glycated hemoglobin levels (blood sugar). While the lack of statistical change over the two year window is surprising, it obscures the primary purpose of insurance: to protect against financial ruin.
“Homelessness is often the result of a downward spiral that begins with illness and ends up in destitution due to health care costs,” said John Lozier, executive director of the National Health Care for the Homeless Council. “The results of the Oregon Health Study show that Medicaid coverage virtually eliminates the risk that health care needs will lead to catastrophic financial costs, undercutting a primary cause of homelessness. Choosing to expand Medicaid will help prevent homelessness.
“It is important to remember that there is no statistically significant evidence that private insurance, Medicare, or other form of health insurance improves health outcomes either,” continued Lozier. “The purpose is first and foremost financial protection—protection that most people value and seek out if they have the financial means to do so. Let’s not apply an additional standard in determining the value of health insurance for the poor.”
Additional findings of the Oregon study included a 30% reduction in depression, increased use of preventative services like mammograms and colonoscopies, and increased use of health care services generally. The statistically insignificant changes in blood pressure, cholesterol, and glycated hemoglobin levels may also be a function of the short study time (two years) or the relatively small sample size of beneficiaries with these conditions.