April 08, 2016 03:22 PM UTC

Throwing Poor People Off Medicaid: a "Moral Mandate?"

• 13 Comments
• by: Colorado Pols

A guest opinion piece in the Colorado Statesman today from Republican Sen. Owen Hill of Colorado Springs attempts something novel: to make an affirmative moral case for cutting back on eligibility for Medicaid health coverage. Other Republican Colorado lawmakers like Senate President Bill Cadman and Sen. Laura Woods have called for rescinding eligibility for Medicaid, but Hill takes the argument a step further by claiming that throwing poor folks off their health coverage might actually be good for them:

Medicaid is failing Colorado. For those of us who love this strong and beautiful state, the time has come for us to do something about it and align our economic and moral interests…

Shockingly, 23 percent of the American population is covered by Medicaid. This means that 73 million people are dependent upon this failing program for health care. Under Obamacare and the Democrat championed Medicaid expansion, enrollment in Medicaid has increased 77 percent in the last two years, making us the fastest growing Medicaid state in the nation. Today, almost one in four Coloradans are depending upon this failing program for daily health care.

Perhaps these complaints about the relentless growth of government-run Medicaid would be mitigated if we were gaining healthier lives, but the real tragedy is that for all this money, we are actually harming many of the people who depend on Medicaid. Yes, a growing number of studies show that for certain conditions patients’ health is found to be worse when they are dependent on Medicaid than if they had no insurance at all. [Pols emphasis]

You’re reading this right, Sen. Hill is claiming that an uninsured patient–for ‘certain conditions’ anyway–could have a better outcome than the same person with Medicaid health coverage. Hill cites a study from a “free market” health researcher named Avik Roy, who published a study pushed by right-wing interest groups that makes this startling claim.

But as health expert Timothy Jost of Washington and Lee University writes of Roy’s research, he often relies on presumptions that aren’t well supported:

Roy…has his own hobby horses. He claims that people are better off being uninsured than on Medicaid and trots out a long list of studies that he claims show negative effects from Medicaid coverage. The methodology of some of these studies is problematic (as the authors of some of the studies admit), while others do not actually show what Roy claims they do. [Pols emphasis]

A little more on Roy’s research via Media Matters from a VA health economist:

My take-away from the Medicaid-IV literature review is: there is no credible evidence that Medicaid results in worse or equivalent health outcomes as being uninsured. [Pols emphasis] That is Medicaid improves health. It certainly doesn’t improve health as much as private insurance, but the credible evidence to date–that using sound techniques that can control for the self-selection into the program–strongly suggests Medicaid is better for health than no insurance at all.

The notion that someone with health coverage might have a worse outcome than an uninsured patient is, of course, counterintuitive on its face. Health insurance allows for long-term management of health problems well beyond the limited scope of care provided by emergency room visits. Obvious questions of correlation vs. causation present themselves in this study, and it doesn’t appear that Roy makes any more than a token attempt to answer them–most likely because the only people who buy this line have a pre-existing ideological problem with Medicaid.

Once you understand this, any “moral case” for throttling back Medicaid eligibility quickly falls apart. But worse than that, Hill’s attempt to justify doing so becomes something else entirely: apologetics, running shallow, pseudo-intellectual, pseudo-moral cover for doing something everybody knows will hurt real people.

And folks, that is not what Jesus would do.