There are some eternal debates that may never be settled. If there is a God, why does God allow evil in the world? Great taste, or less filling? And of course, does Medicaid make people healthier?
I’m not going to rehash that last debate here, which I have covered many times. Suffice it to say that while liberals insist that the evidence is clear that health insurance expansions improve physical health, at least modestly, I do not see that the evidence warrants the confidence they exude. The intuitive sense that this ought to be correct seems to me to be doing a lot of heavy lifting in these evaluations. In health care, our intuitions are often wrong.
(Related: How Has the ACA Affected People’s Health?)
We’ll probably find it easier to settle a related debate, which is often mistaken for the same debate: Does Medicaid make people better off?
After all, it’s possible that Medicaid does nothing for your objective physical health, but makes you better off simply because you are under the impression that you are now at less risk of disease or dying. Peace of mind is valuable. (Just ask an insurance company how much we’re willing to pay for it.) And as you can readily see from any pharmaceutical clinical trial, the placebo effect is quite real, and often quite significant; the people who experience it are still better off, even if the abatement of their symptoms begins in their minds.
And of course, Medicaid may also make people financially better off. It is possible that most people manage to get medical care somehow, when they really need it (and are willing to comply with often onerous regimens). But those people will be left with debts, or have to cheat other priorities in order to ensure that the doctor gets paid. For the poor and near-poor, especially, this is a heavy burden: They have fewer resources to pay the bills, and for a variety of reasons, are more likely to be sick in the first place.
And here, we have considerably better evidence for a benefit. A randomized controlled study of Medicaid access in Oregon, which ultimately failed to find any statistically significant improvement in objective health markers, unequivocally found that the people who got Medicaid experienced less financial distress than those who didn’t. Over at Mother Jones, Kevin Drum points to another recent study showing the same result, from the Consumer Financial Protection Bureau. It suggests that in the states that accepted Obamacare’s Medicaid expansion, medical debt dropped dramatically compared to the states that declined the expansion. “So: Does Medicaid work?” writes Drum. “Yes indeed. It has moderate but positive effects on health, and very large effects on medical debt.”
It is customary at this juncture for me to offer the caveat that this is only one study, and no one study is definitive. I therefore offer it. Nonetheless. I would be very surprised if we later discover that no one got a financial benefit from the Medicaid expansion.