Expanding Medicaid Coverage Offers Mixed Health Results Study Suggests

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The Affordable Care Act will expand Medicaid coverage in the United States. Each state operates a Medicaid program that offers health insurance for lower income people, families and children, older people, and people with disabilities. The eligibility rules for Medicaid are different for each state, but most states offer coverage for adults with children at some income level.

Starting in 2014, most adults younger than 65 who earn up to about $15,000 per year will qualify for Medicaid in every state because of the Affordable Care Act.

Many policy experts have wondered about the effects of expanding Medicaid coverage: Would people be healthier with Medicaid coverage than with no insurance?

In 2008, the state of Oregon expanded its Medicaid program though a lottery system. About 30,000 people were randomly chosen to be eligible for Medicaid coverage from a waiting list of almost 90,000 people. This gave researchers an opportunity to compare the effects of Medicaid coverage on the health of people who had Medicaid coverage to people who didn’t. Overall, they found that Medicaid coverage didn’t really improve the specific health outcomes being measured (high blood pressure and high cholesterol), but did increase the use of many preventive services, increased the rate of diabetes diagnoses, lowered depression rates, and reduced the strain of paying for health care, especially for catastrophic medical emergencies and events.

The study was published on May 2, 2013 by the New England Journal of Medicine. Read the abstract of “The Oregon Experiment – Effects of Medicaid on Clinical Outcomes.”

While this study didn’t look specifically at breast cancer, it does look at whether there is a difference between having Medicaid and having no insurance in terms of general health outcomes.

The researchers interviewed 12,229 people:

  • 6,387 were lottery winners who became eligible for and then enrolled in Medicaid
  • 5,842 were not selected by the lottery and continued to have no insurance

The two groups were similar in terms of gender, age, and ethnicity.

Two years after the lottery winners enrolled in Medicaid, the researchers asked the all the people in the study to fill out detailed questionnaires on their health and insurance coverage, the medicines they took, quality of life, and the healthcare services they used. The researchers also measured the participants’ blood pressure, took a blood sample, and assessed depression with a screening tool.

The researchers found that the number of people with high blood pressure, high cholesterol, and high glycated hemoglobin levels (a blood measure used to diagnose diabetes) was about the same in both groups.

Medicaid coverage also didn’t affect:

  • the number of visits to emergency rooms
  • the number of hospitalizations
  • the likelihood that a person was obese or smoked

Still, people who had enrolled in Medicaid were:

  • more likely to have been diagnosed with diabetes and be using medicine to control diabetes
  • about 30% less likely to be depressed, according to screening tool scores
  • more likely to say that their health was the same or better than it was the year before
  • less likely to have financial problems because of medical costs; catastrophic medical expenses (out-of-pocket expenses that were more than 30% of a person’s income) were nearly eliminated for people with Medicaid coverage
  • using more prescription medicines
  • visiting the doctor more often than the year before
  • more likely to have cholesterol screening
  • more likely to report that they had better access to care

Because the study looked at the effects of Medicaid for only 2 years, it’s unlikely that it will end the debate about the Affordable Care Act’s call to dramatically expand Medicaid. Still, the researchers said they have more data to analyze, so more reports may be published.

No matter your insurance status, if you’ve been diagnosed with breast cancer, remember there is only one of you and you deserve the best care possible. Don’t let any obstacles get in the way of your treatment.

If you don’t have insurance or are unemployed, paying for treatment may seem overwhelming. Don’t panic and don’t skip any treatments or doctor’s visits. There are resources available to help you.

Someone at your doctor’s office may be able to give you a list of organizations that offer financial assistance for breast cancer medicines and care, as well as local organizations that offer financial assistance for your practical needs such as transportation, food, and child care. Many pharmaceutical companies have set up special funds to help pay for the cost of their medicines.

Also, many hospitals now include patient navigators as part of the breast cancer care team. A patient navigator can help you understand and move through the health care and insurance systems. Patient navigators also can help overcome language and cultural barriers, as well as any biases based on culture, race, or age. Ask your doctor or nurse for a patient navigator recommendation.

For more information on financial help for people with and without insurance, including tips to lower medicine costs, visit the Paying for Your Care pages in the Breastcancer.org Day-to-Day Matters section.

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