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Medicaid Critics Misusing Research to Make Their Case, Health Policy Experts Write


“There are many things wrong with Medicaid but to take this research and say people would be better off with nothing is hard to swallow,” said Aaron Carroll, M.D., director of the Indiana University Center for Health Policy and Professionalism and professor of pediatrics at the IU School of Medicine.

“They are taking studies that are not designed to show cause and effect saying Medicaid causes bad outcomes, and that’s just not appropriate,” he said.

Co-authors of the paper are Austin Frakt, Ph.D., assistant professor at Boston University School of Public Health; Harold A. Pollack, Ph.D., the professor at the School of Social Service Administration, the University of Chicago; and Uwe Reinhardt, Ph.D., professor of economics and public affairs at Princeton University. Medicaid, which is funded both by federal and state governments, provides health care coverage for very low income Americans.

The authors are responding to a recent editorial in the Wall Street Journal by a physician associated with a conservative think tank arguing Medicaid patients have significantly poorer health outcomes than do patients with no insurance at all.

The problem, the authors note, is that the studies cited don’t attempt to show that the Medicaid program itself is the cause of the different health outcomes. Other more sophisticated studies that do a better job of accounting for problems Medicaid recipients face show a benefit from Medicaid participation, Dr. Carroll said.

Moreover, critics who say the program results in worse health care aren’t stating what about the program causes the problem, the journal authors say.

“If you believe in the causal link you have to have a rationale,” said Dr. Carroll. “The two we can think of are, first, you believe that physicians who accept Medicaid are less skilled than physicians who do not, even though the places that accept Medicaid are often academic medical centers.

“Second is that physicians are so callous that if they know it’s a Medicaid patient they don’t try as hard.”

“We don’t think those are true. If they believe there’s another argument they should lay it out,” Dr. Carroll said.

The authors agree that low rates of reimbursement and other problems plague Medicaid, But, they write, critics “are using the invalid argument that Medicaid coverage is worse than no coverage at all to support proposals to cut back the program.

“Such an attack further damages this highly challenged program by undermining the political case for additional resources.”