Oregon Study Throws a Stop Sign in Front of ObamaCare’s Medicaid Expansion

Today, the nation’s top health economists released a study that throws a huge “STOP” sign in front of ObamaCare’s Medicaid expansion.

The Oregon Health Insurance Experiment, or OHIE, may be the most important study ever conducted on health insurance. Oregon officials randomly assigned thousands of low-income Medicaid applicants – basically, the most vulnerable portion of the group that would receive coverage under ObamaCare’s Medicaid expansion – either to receive Medicaid coverage, or nothing. Health economists then compared the people who got Medicaid to the people who didn’t. The OHIE is the only randomized, controlled study ever conducted on the effects of having health insurance versus no health insurance. Randomized, controlled studies are the gold standard of such research.

Consistent with lackluster results from the first year, the OHIE’s second-year results found no evidence that Medicaid improves the physical health of enrollees. There were some modest improvements in depression and financial strain–but it is likely those gains could be achieved at a much lower cost than through an extremely expensive program like Medicaid. Here are the study’s results and conclusions:

We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression [by 30 percent], increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures…

This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.

As one of the study’s authors explained to me, it did not find any effect on mortality because the sample size is too small. Mortality rates among the targeted population – able-bodied adults 19-64 below 100 percent of poverty who aren’t already eligible for government health insurance programs – are already very low. So even if expanding Medicaid reduces mortality among this group, and there is ample room for doubt, the effect would be so small that this study would be unable to detect it. That too is reason not to implement the Medicaid expansion. This is not a population that is going to start dying in droves if states decline to participate.

There is no way to spin these results as anything but a rebuke to those who are pushing states to expand Medicaid. The Obama administration has been trying to convince states to throw more than a trillion additional taxpayer dollars at Medicaid by participating in the expansion, when the best-designed research available cannot find any evidence that it improves the physical health of enrollees. The OHIE even studied the most vulnerable part of the Medicaid-expansion population – those below 100 percent of the federal poverty level – yet still found no improvements in physical health.

If Medicaid partisans are still determined to do something, the only responsible route is to launch similar experiments in other states, with an even larger sample size, to determine if there is anything the OHIE might have missed. Or they could design smaller, lower-cost, more targeted efforts to reduce depression and financial strain among the poor. (I propose deregulating health care.) This study shows there is absolutely no warrant to expand Medicaid at all.

View the original article here

Portland, Oregon Becomes Fourth American City To Adopt Paid Sick Day Law

Our guest blogger is Jane Farrell, a Research Assistant for economic policy at the Center for American Progress Action Fund.

Portland became the fourth American city to approve a paid sick days law Wednesday, an important step forward today that will help the city’s workers, employers, and residents. Portland joined three other cities – San Francisco, Washington DC, and Seattle – and one state, Connecticut, in modernizing its workplace policies and acknowledging an important reality: everybody gets sick but no one should be at risk of losing a job, infecting coworkers or customers, or missing a day’s pay because of an illness.

While the economic and social benefits of paid sick days are numerous, Portland City Councilmembers nevertheless weighed the evidence in favor of and against paid sick leave carefully. Ultimately, they unanimously decided that this policy would help make Portland a stronger city and community. Worker-friendly policies like paid sick leave help reduce turnover, saving businesses time and money they might have spent on training, hiring, and replacing employees. It also strengthens worker loyalty and increases worker productivity.

Paid sick leave also helps lower health care costs by reducing the number of costly emergency room visits Portland hospitals will have to finance or subsidize. While 40 percent of private sector workers across the US lack even one paid sick day, Portland residents who previously lacked this protection can now rest easy – and work even more diligently – knowing they are safe and covered.

View the original article here

Oregon Study Throws a Stop Sign in Front of ObamaCare’s Medicaid Expansion

Today, the nation’s top health economists released a study that throws a huge “STOP” sign in front of ObamaCare’s Medicaid expansion.

The Oregon Health Insurance Experiment, or OHIE, may be the most important study ever conducted on health insurance. Oregon officials randomly assigned thousands of low-income Medicaid applicants – basically, the most vulnerable portion of the group that would receive coverage under ObamaCare’s Medicaid expansion – either to receive Medicaid coverage, or nothing. Health economists then compared the people who got Medicaid to the people who didn’t. The OHIE is the only randomized, controlled study ever conducted on the effects of having health insurance versus no health insurance. Randomized, controlled studies are the gold standard of such research.

Consistent with lackluster results from the first year, the OHIE’s second-year results found no evidence that Medicaid improves the physical health of enrollees. There were some modest improvements in depression and financial strain–but it is likely those gains could be achieved at a much lower cost than through an extremely expensive program like Medicaid. Here are the study’s results and conclusions:

We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression [by 30 percent], increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures…

This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.

As one of the study’s authors explained to me, it did not find any effect on mortality because the sample size is too small. Mortality rates among the targeted population – able-bodied adults 19-64 below 100 percent of poverty who aren’t already eligible for government health insurance programs – are already very low. So even if expanding Medicaid reduces mortality among this group, and there is ample room for doubt, the effect would be so small that this study would be unable to detect it. That too is reason not to implement the Medicaid expansion. This is not a population that is going to start dying in droves if states decline to participate.

There is no way to spin these results as anything but a rebuke to those who are pushing states to expand Medicaid. The Obama administration has been trying to convince states to throw more than a trillion additional taxpayer dollars at Medicaid by participating in the expansion, when the best-designed research available cannot find any evidence that it improves the physical health of enrollees. The OHIE even studied the most vulnerable part of the Medicaid-expansion population – those below 100 percent of the federal poverty level – yet still found no improvements in physical health.

If Medicaid partisans are still determined to do something, the only responsible route is to launch similar experiments in other states, with an even larger sample size, to determine if there is anything the OHIE might have missed. Or they could design smaller, lower-cost, more targeted efforts to reduce depression and financial strain among the poor. (I propose deregulating health care.) This study shows there is absolutely no warrant to expand Medicaid at all.

View the original article here

Oregon Is The Only State Left That Hasn’t Imposed Any Restrictions On Abortion

Despite the fact that Roe v. Wade first legalized abortion four decades ago, anti-choice lawmakers have successfully chipped away at abortion rights on a state level. Wonkblog’s Sarah Kliff flagged a helpful visual, compiled by Remapping the Debate, to illustrate the recent flood of anti-abortion laws across the country (click to enlarge, or click here to see the interactive version). Five states have at least 20 different restrictions that obstruct women’s access to reproductive services, and Oregon is the sole state that doesn’t have a single piece of anti-choice legislation on the books:

View the original article here

Oregon Man Begs For Kidney Donor On The Street

Earl Martinez is a 28-year-old Oregonian suffering from Alport Syndrome, a genetic kidney disorder that has forced him to undergo dialysis treatments for the past year and a half. In order to survive, he needs a new kidney, but the hereditary nature of his disease makes it impossible for his family to provide it. So, after waiting on a transplant list for over a year, Martinez has taken a more active role in addressing his medical needs — by begging for a kidney donor on the side of an Oregon road, CBS News reports.

Money is no obstacle for Martinez, who has health insurance. “My insurance would cover all medical costs on my side and the donor’s side,” Martinez told local CBS affiliate KOIN. “The donor would have no medical costs at all.”

But coverage alone isn’t enough for the approximately 113,000 Americans on an organ transplant waiting list — 80 percent of whom need a new kidney. According to a 2009 Rutgers Law Review article, only 30,000 transplants are performed in America every year. That meets less than a third of the annual demand and leads to 20 American deaths every day due to the lack of organ donors, and 4,000 deaths annually from too few kidney transplants.

Studies suggest that America’s dearth of organ donors may have to do with public health policy. The U.S. relies primarily on an “opt-in” system when it comes to organ donation, meaning that potential donors must actively volunteer to donate, as many Americans do at the DMV after receiving a driver’s license. But other nations’ experiences with organ donation policy suggest that an “opt-out” system — which always presumes a person’s consent upon death, unless that person or his family refuses — could be more effective. Austria, an “opt-out” nation, has a staggering donation consent rate of 99.98 percent, for example.

Still, despite its donor shortage, the U.S. ranks third worldwide in overall organ donation rates after death. And even in states like Oregon, where 70 percent of residents over the age of 18 are registered donors, there are only 274 organ transplants performed annually — suggesting that a lack of registered donors isn’t the root of the problem. The answer to this dilemma may actually lie in the source of Americans’ demand for organs.

The vast majority of U.S. residents waiting for a transplant need a kidney, and the most common causes of chronic kidney disease are diabetes and high blood pressure. It follows that America’s diabetes and obesity epidemic is in large part responsible for the nation’s unsustainable demand for kidney transplants. Addressing the soaring rates of obesity in the U.S., and therefore improving the health of the general population, could help reduce America’s demand for organ transplants. And that could give Americans like Martinez — who has no control over his disease — a much-needed leg up on the waiting list.

View the original article here