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
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
This is just a fluff piece about a garbage study. That’s just sad.
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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.
“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.
“…social determinants of health…”
The ABFM has a nice MOC module for that . Enjoy!
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.
From your website: “Dr. Hollywood is Board Certified in Family Medicine.” So this is not true then?
I should clarify. I am not board certified by the ABFM who require MOC. I am board certified by the NBPAS.
“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).
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?
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.
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.
“a higher likelihood of maintaining baseline health status over time”
I guess they stopped aging?