Medicaid Expansion

The topic of Medicaid expansion is fraught with politics. I am going to stay away from that a bit. Here is the article I want to talk about in full:

A new study finds that Medicaid expansion improved people’s health in Southern states, resulting in fewer declines in people’s health. 

The study published in Health Affairs finds that Medicaid expansion made declines in health status 1.8 percentage points less likely in states that expanded the medical coverage. 

It examined 12 Southern states, including those that have accepted the expansion of Medicaid under the Affordable Care Act, like Kentucky, West Virginia, Arkansas and Louisiana, and those that have not, like Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina and Tennessee.

“We found that Medicaid expansion was associated with lower rates of self-reported health declines and a higher likelihood of maintaining baseline health status over time,” the study finds. 

A majority of the 14 states that have rejected the expansion of Medicaid are in the South. 

Resistance to Medicaid expansion has been declining, with multiple red states accepting the expansion in recent years, often through ballot initiatives that put the question to voters in the state. 

Medicaid expansion passed by ballot initiative in Utah, Nebraska and Idaho in 2018. 

Protecting Medicaid was one of the top rallying cries for activists fighting Republican ObamaCare repeal efforts in 2017, and advocates are now trying to build on that movement by expanding the program in the 14 states that are still resisting expansion. Texas and Florida are the main prizes, as they have the highest populations of the holdout states.

“Medicaid expansion improved health,” John Graves, one of the study’s authors and a professor at Vanderbilt University, wrote on Twitter. “But improvements are as much, if not more, a result of stemming of health declines as they are a result of moving people to better states of health.”

First, of course giving free care will improve health to a certain amount. I think we all get that so no big deal there. But 1.8%? Talk about a bang for your buck huh? Then there is the measurement of “lower rates of self-reported health declines and a higher likelihood of maintaining baseline health status over time.” I really have no idea what that means. Self-reported measures are usually terrible indicators as well.

I want a healthier population. I want a better way to deliver that healthcare. I’m sorry but Medicaid expansion, as shown by these results, is not an overwhelming success. Sorry. There just has to be a new way.

This is just a fluff piece about a garbage study. That’s just sad.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  11 comments for “Medicaid Expansion

  1. Jennifer Hollywood
    January 15, 2020 at 7:40 am

    I have many patients who have significantly benefited from Medicaid. The asthmatic who is now on a controller inhaler and doing great. Previously he went to the ER several times a year. His inhaler cost too much. He hasn’t been to the ER in years since getting Medicaid. His asthma is stable. He previously had tried to get insurance but no one would cover him due to his asthma. Otherwise healthy working male. There are many similar stories. But what Medicaid cannot change are the other social determinants of health. It can’t make people exercise or eat well or get enough sleep. That is where we next have to focus. We need to change the American culture to value health. Eating healthy and exercising. Getting enough sleep. Employers need to let their employees go to the doctor. Obesity needs to be unacceptable. But that is an entirely different challenge.

    • R Stuart
      January 15, 2020 at 8:16 am

      “It can’t make people exercise or eat well or get enough sleep . . . We need to change the American culture to value health”

      That’s too hard.

      Much easier just to blame the doctors.

    • Pat
      January 15, 2020 at 1:08 pm

      “…social determinants of health…”

      The ABFM has a nice MOC module for that . Enjoy!

      • Jennifer Hollywood
        January 15, 2020 at 1:51 pm

        I’m not board certified. And I don’t do MOC. And the social determinants of health are NOT my responsibility. But they do exist.

        • IMMD
          January 16, 2020 at 9:14 am

          From your website: “Dr. Hollywood is Board Certified in Family Medicine.” So this is not true then?

          • Jennifer Hollywood
            January 16, 2020 at 2:36 pm

            I should clarify. I am not board certified by the ABFM who require MOC. I am board certified by the NBPAS.

        • R Stuart
          January 16, 2020 at 9:30 am

          “I’m not board certified. And I don’t do MOC”

          Good for you.

          I let my certification lapse a decade ago, and it’s been smooth sailing (don’t do in-patient).

    • Bridget Reidy
      January 16, 2020 at 2:04 pm

      Obesity already is culturally unacceptable. I don’t think treating them with contempt has worked the past few decades at least, and letting agribusiness and cardiologists/big Pharma dictate our food guides has probably made it worse so it’s not a simple case of good scientists and evil consumers. Exaggerating the health risks of obesity has also been ineffective and resulted in a public who thinks it’s OK to not exercise and have abdominal obesity and drink two to three drinks every day as long as you don’t look like a health risk. So just what are you proposing here? Do you plan to treat a BMI 35 with no other features of metabolic syndrome and who has maintained a 50# weight loss as equally or more unacceptable than a young 30 gaining a point every year?

      • Jennifer Hollywood
        January 16, 2020 at 2:45 pm

        I am not treating them differently at all. We as a society need to change the culture in the US so that the patient wants to change their BMI. The patient wants to exercise. So that the patient wants to eat healthy. So that restaurants and grocers offer healthier food choices. So that people pick healthier foods at the market and that unhealthy foods just fall out of favor and go away. So that people choose to walk places and not drive. And that cities make walking easy and safe and accessible. But in the US Americans want more meat, bigger cars, to drive everywhere, to supersize everything, and to make unhealthy choices. Our society does not try to improve access to walking trails and pedestrian/biker safe walkways and public transportation. Employers do not encourage their employees to take breaks and exercise and get fresh air. We celebrate 60 hour work weeks and take few vacations. We need to work on improving our entire well being. Physical and emotional. In that obesity is culturally unacceptable, there are shows that celebrate morbid obesity. We are berated if we “fat shame” people. There is some acceptance of obesity is modern society. Yes, thinness is still preferred by most, but obesity is now more acceptable than ever.

  2. Pat
    January 14, 2020 at 4:10 pm

    Sure bet that those conducting / funding the study are pro-Medicaid expansion. Medicaid is an animal born of politics as an add-on to the creation of Medicare. I don’t see how it can be examined outside of that context.

  3. R Stuart
    January 14, 2020 at 3:56 pm

    “a higher likelihood of maintaining baseline health status over time”

    I guess they stopped aging?

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