This paragraph is from CBS. It is very deceiving intending to bring political debate without complete facts.
AP January 2, 2014, 4: 05 PM
SALEM, Ore. -- A new study (click here) has found that people enrolled recently in Medicaid went to the emergency room 40 percent more frequently than others, often seeking help for conditions that could be treated less expensively in a doctor's office or an urgent care clinic....
The study was recently published in "Science," but, the Medicaid expansion occurred in 2008. It was offered in Oregon before The Patient Protection and Affordable Care Act was even law.
...The study by Sarah Taubman (click here) of the National Bureau of Economic Research and colleagues is the third in a series detailing results from an Oregon-based experiment begun in 2008, in which low-income adults were randomly given Medicaid coverage. The adults were later surveyed to gauge the effects of the coverage on their health and well-being.
Called the Oregon Health Insurance Experiment, it was designed to shed light on the effects of guaranteeing Medicaid coverage for low-income, uninsured adults, an important topic in the United States since insurance for the poor is a big component of the 2010 Affordable Care Act....
There were federal monies involved to sponsor this study? This was suppose establish the effects of the law on a control population? Is that right? Because that is not what Oregon says.
The Oregon Health Insurance Experiment (click here) is a landmark, randomized study of the effect of expanding public health insurance on the health care use, health outcomes, financial strain, and well-being of low-income adults. It represents the first use of a randomized controlled design to evaluate the impact of Medicaid in the United States. Although randomized controlled trials are the gold standard in medical and scientific studies, they are rarely possible in social policy research. In 2008, the state of Oregon drew names by lottery for its Medicaid program for low-income, uninsured adults, generating just such a randomized controlled design. This ongoing study represents a collaborative effort between researchers and the state of Oregon to use this opportunity to learn about the costs and benefits of this expansion of public health insurance.
"Probably of Hospital Admission"
Hm.
You know what this means to me? It means those of low income cannot necessarily discern whether they are sick enough to be hospitalized. That is all that means to me.
- Medicaid increased the likelihood of being admitted to the hospital by 30 percent, driven by hospital admissions not originating in the emergency department.
- The Poor have been sicker than the average American and until they receive quality care they remain under or uneducated to what appropriate health care provides to improve their health status.
- Medicaid increased the likelihood of using outpatient care by 35 percent, using prescription drugs by 15 percent, but did not seem to have an effect on use of emergency departments.
- Financial hardship
- Medicaid decreased the probability of having an unpaid medical bill sent to a collection agency by 25 percent – which also benefits health care providers since the vast majority of such debts are never paid.
- Self-reported health and well-being
- Medicaid increased the probability that people report themselves in good to excellent health (compared with fair or poor health) by 25 percent.
- Medicaid increased the probability of not screening positive for depression by 10 percent.
- Emergency department visits overall
- Medicaid increased the number of emergency department visits over the 18-month period by about 40 percent (0.41 visits, relative to a base of 1.02).
- This is the part the media is presenting as controversial adding to the cost of health care by the use of emergency rooms. The study was conducted 2 years after the Medicaid expansion lottery was conducted, so that places the information in 2010. Basically, the program is excellent. The visits were not frivolous and conducted by the patients on a whim, the visits were all purposeful. There were approximate 40% increase in emergency room use by Medicaid Expansion recipients. The demographics didn't change as to types of visits. However, the 40% also included, "We found no statistically significant increase in emergency department visits that did result in hospital admissions." That means the SAME STATISTICAL RESULT for hospital admissions were the same. That statistical result was 40% more. The reason there is a neutral calculation is because with 40% more visits it included the same number hospitalized.
- I didn't see any speculation by the study that explains why the ER was a venue of choice. Were there no Medicaid Primary Physicians in the patients of the lottery? Was this the community's habit? Was there misinformation given the recipients by a Social Worker. Was there NOT a Primary Physician assigned to them and if assigned to a Primary Physician did they not like that physician? There are many reasons why this would occur and it is missing from the study.
- Types of visits and subpopulations
- Medicaid coverage increases use of the emergency department across the broad range of types of visits and subgroups. Moreover, we did not find statistically significant decreases in emergency department use in any of the subpopulations we examine.
- Medicaid increased visits occurring during standard hours (weekdays 7am-8pm) and visits outside of standard hours (weekends and evenings). Both types of visits increased by over 40 percent (0.23 visits relative to a base of 0.57, and 0.21 visits relative to a base of 0.46, respectively.
- Medicaid increased use for visits classified as "non-emergent," "primary care treatable," and "emergent, preventable." We found no statistically significant change in the use of visits classified as "emergent, non-preventable."
- Medicaid increased outpatient emergency department visits (visits that did not result in a hospital admission). We found no statistically significant increase in emergency department visits that did result in hospital admissions.
I am really surprised at the level of malice by the Press with this population of Americans.
By Jordan Rau
May 10, 2013
A study of Oregonians (click here) who won Medicaid benefits in a 2008 state lottery has sparked an intense debate about the value of expanding health care to the poor -- and the value of health benefits in general.
I have a problem with that paragraph. The idea that health care benefits are or are not valuable to a person's life is bizarre. Everyone deserves health care and if it lifts their depression that is valuable.
Mary Carson is, in a way, at the center of that debate. The 55-year-old Oregon woman was accepted into the Oregon Health Plan, the state Medicaid program, in 2011. She and her partner live with her three children. They earn about $1,000 a month by making and selling replicas of historic battle knives used in the Civil War and the two World Wars, doing odd jobs and providing respite care for people with cancer.
"It took me 6 months to change my level of co-operation with my doctor, and she said I was faster than many," Carson recently recounted in blog comments that recently drew media attention. "Most people got into the groove about their 2nd physical. Then we had year-to-year values for blood tests and weight and blood pressure. Those numbers getting better helped."
This population has been chronically neglected for decades, which raises the question, what kind of value is the American society looking for when approaching health care with this population? There won't be miracles. They aren't going to change overnight if they have a Medicaid card. Much of their health care will have to be learned. They are used to avoiding care except for serious problems. Having Medicaid opens the door of opportunity for removing that strategy.
This population will have more visits after they have Medicaid, simply because they have neglected their health for a long time and are finally catching up. The hospitals will receive monies for their visits where they never received any before. The fact this population of Americans need to adjust to having health care insurance and the best approach to use it should be a surprise to no one.
The researchers in the New England Journal of Medicine looked at patients much like Carson. In results published last week, they found that those who gained Medicaid coverage used more health services than low-income residents who had not been accepted into the program. But the Medicaid enrollees did not show significantly better blood pressure, cholesterol and blood sugar levels than the other group, although they had lower rates of depression....
No clue. The folks without Medicaid AVOID health care because they can't afford it. Why spend monies on a physician visit if one cannot afford the medication?
The lack of improvement of blood pressure, cholesterol and blood sugar are all issues of DIET as well as medication. If a person has high blood pressure they need medication but they also have to improve their diet by minimizing salt content. If a person has high cholesterol they have to minimize fats in their diet. If a person's blood sugar doesn't change it is because they have to limit carbohydrates in their diet.
These folks receive Food Stamps/SNAP. Every dollar of food assistance has to go a long way from month to month. That does not lend itself to seek out high end grocery stores.
Additionally, those three medical conditions like , hypertension, hypercholesterolemia and diabetes requires weight loss and
exercise in order to improve outcomes. There is a chance that can happen with
those eligible to Medicaid, but, what do we know by the statements of this participant? These Americans are slow to change. Their 'range' of opportunity to change is limited, so they need strategies they have never been equipped with before. Does that mean they don't deserve health care because it doesn't carry the same value as other Americans? No, it means we have more work to do to bring them up to speed and seek the best strategy for their medical compliance.
A family of five living on $1000 per month is profound poverty and there are families in the USA living on less. So, when they are presented with changing their habits to improve their health and well being, it isn't easy. They have to change within a very tight budget. This population of Americans are difficult to change in their outcomes. It isn't because they don't want health care, it is because they are not equipped to carry out COMPLIANCE in the same why as other Americans with higher incomes. This population is a challenge, but, they are not a challenge we can or should ignore nor a challenge to far.
In the United States, hunger is not caused by a scarcity of food, but rather the continued prevalence of poverty. Both issues must be addressed in our continued efforts to help those Jesus called "the least of these" (Matthew 25:45)....
Who thought this nation would ever be looking at a poverty rate of 14.5 percent? Yet we are. As more and more Americans fall into poverty the demand for our attention as a nation is vital. No person is disposable simply because their socio-economic condition is lousy.
Who ever thought Bernie Madoff would ruin lives? Who ever thought Americans would lose their 401Ks. Who ever thought Americans would lose their homes because Wall Street was greedy and stupid and needed a bailout. Who ever thought Wall Street would take their monies and run without providing loans vital to businesses in the USA to return jobs to the people of the country?
Those forced into poverty after 2008 were not your usual worries. Those folks were usually the ones worrying about those in poverty and now the tables were turned and they were the needy.
That reality tells me every American needs to pay attention to those in need because tomorrow has proven to be unpredictable in ways no one could imagine.
I have to laugh at Republicans. They say things like, "That is September 10th thinking," but, they never say, "That is Pre-2008 thinking."
There should be a clear understanding by every American that policies effecting the Poor are important, especially because of 2008.
There is no going back. We are not going to do that. We need to get on with this and begin the 'fit' we need to assist the most challenging health care issues including the lethargy of the Poor to grasp change and incorporate it into their lives.
.jpg)
.gif)
