Clipboard: Study finds gains for mental health, but not physical health, in Medicaid recipients

A new analysis of Oregon residents chosen at random from a pool of uninsured people to receive Medicaid coverage has found that after about two years, the health of recipients did not improve on key measures, such as blood pressure or blood sugar levels. But fewer of those on Medicaid were depressed.

The group of researchers, led by two from the Harvard School of Public Health and Massachusetts Institute of Technology, published a paper in 2011 that found those who gained coverage through the Medicaid lottery reported feeling better, physically and mentally, and having less financial strain.

Julie Rovner of National Public Radio reports:

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For this current study, however, the researchers wanted to go a little deeper. Rather than just asking people if they felt better, they wanted to see if they actually were healthier after getting Medicaid coverage.

So they did personal visits that included medical tests, like blood pressure and cholesterol screening.

But the results there weren’t so positive. There was no statistically significant difference between the Medicaid group and the control group in those measures.

The new study adds some nuance to the “Medicaid is good” versus “Medicaid is evil” debate, Carey Goldberg of WBUR’s Commonhealth blog writes:

That “mixed message,” in fact, is the bottom line, says lead author Katherine Baicker, a health economics professor at the Harvard School of Public Health.

“There are substantial benefits, but they’re not uniform across all outcomes,” she said. “It’s too easy to have a black or white view of the program.”

If you’re a big Medicaid fan, the study’s findings may well disappoint you. Among winners in Oregon’s Medicaid lottery, after about two years with coverage, it found no measurable improvement on several important health measures: high blood pressure, cholesterol, blood sugar control in people with diabetes.

On the other hand, the study did find a dramatic drop in depression among people newly covered by Medicaid, and — not surprisingly — a great easing of the financial strain caused by medical expenses. In the two years it followed the lottery winners, it also found an increase in diagnoses of diabetes and in the use of medication for diabetes.

Boston health economist Austin Frakt, who has argued for Medicaid expansion, dissected the paper with colleague Aaron Carroll on the Incidental Economist blog. One point they make: “Improvements in mental health are still improvements in health outcomes.”