October 24, 2013

Nick Gillespie appeared on Crossfire earlier this week representing the libertarian elite who not only hate the mandate but also think that poor people will somehow magically not be poor if we take every service they have away from them. In this little segment, he disingenuously cites an Oregon study with the claim that health outcomes for Medicaid recipients are no better than they would be without Medicaid.

That study has been debunked six ways from Friday, but that doesn't stop Gillespie from using it like gospel. Fortunately, Jon Perr looked more carefully at his 'evidence' back in May and fact-checked the claim.

This week, the New England Journal of Medicine published a major study of Medicaid in Oregonwhich has rapidly emerged of a Rorschach test of sorts. That is, partisans on either side of the political divide tend to see what they want to see in its results. While conservatives claim Medicaid expansion has been debunked by numbers showing little change in blood pressure, cholesterol, and diabetes over two years between those who did and did not gain access to Medicaid, liberals tout findings revealing "Medicaid improved rates of diagnosis of depression, increased the use of preventive services, and improved the financial outlook for enrollees.

"Ultimately, as Ezra Klein, Kevin Drum, Aaron Carroll and Austin Frakt all conclude, the limited sample size, short-time frame and narrow measures of "health outcomes" make conclusions about the efficacy of Medicaid difficult to reach. But combined with other recent research, there is little question that Medicaid expansion will make the financial prospects and quality of life significantly better for the previously uninsured. As for the legion of Republican politicians instead insisting "no one goes without health care in America" because "you just go the emergency room," studies documenting the rapid disappearance of ER's and trauma centers show that GOP talking point is just a cruel joke.

Gillespie fails to mention a key point: The ACA Medicaid expansion also requires Medicaid benefits to be ACA-compliant with benefits offered in Silver level policies on the exchange. That means Medicaid recipients will have access to preventive benefits, prescription drug coverage, and a network of doctors and hospitals to deal with their health issues before they become emergencies.

Beyond the mechanics of what the Medicaid expansion means to beneficiaries, what libertarians hate most about the law is that it will actually offer pathways for poor people to climb out of the cycle of poverty. Healthy people are able to work. Access to birth control will give women a way to control their own reproductive health.

Anecdotally, I have known people on Medicaid who would have died without the benefits it provides. Cancer patients, diabetics, and others suffering from chronic conditions cannot survive jumping from emergency room to emergency room. They die.

The truth is, Nick Gillespie, there are clear outcomes to those without Medicaid benefits: death and an endless cycle of poverty. On the other hand, I'm perfectly fine with letting time change those outcomes to something more American, like the possibility of living a life where my health outcome was not dependent on my financial status, where poverty doesn't mean death.

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