Catalyst for Payment Reform

Do you think having health insurance makes you healthier?

Do you think having health insurance makes you healthier?

Tricky question. As this Slate article explains, measuring the effect of providing insurance is difficult because those with insurance and those without may differ in many ways that cannot be controlled. Luckily, there are two studies that tackled this question through randomized control trials and a natural experiment.

The Oregon Health Insurance Experiment randomly assigned Medicaid insurance to low-income people that applied to a lottery for health insurance coverage. Researchers followed the treatment and control groups for two years and found that, while self-reported health and rate of depression improved by a statistically significant margin, there was no significant effect on several measures of physical health like blood pressure rate and cholesterol levels. Researchers also analyzed the impact of Medicaid coverage on health care utilization (it went up for the new recipients), financial hardship (it went down), and labor market outcomes (no change) between the two groups.

study published in JAMA in October of 2016 found that the Medicaid expansion in Kentucky and the use of Medicaid funds to purchase private insurance for low-income adults in Arkansas (private option), compared with no expansion in Texas, were associated with significant increases in outpatient utilization, preventive care, and improved health care quality; reductions in emergency department use; and improved self-reported health. Here’s the New York Times Upshot coverage of this breakthrough research.

With these two studies in your back pocket, the case can be made for health insurance as a tool towards achieving healthier populations. A quick look at KFF’s Fact Sheet on the Uninsured Population paints a clear picture that there’s lots of work to be done in improving the health outcomes of the uninsured: higher rates of avoidable hospitalizations, higher rates of postponing or forgoing needed prescription drugs due to cost, and, worst of all, higher rates hospital mortality. The good news is that expanding health insurance coverage for children has bi-partisan support, as shown by the continued funding for the Children’s Health Insurance Program (CHIP) that passed back in January. CPR recognizes that expanding insurance coverage is an important factor to achieving a well-functioning health system, and we take pride in helping health care purchasers, including state Medicaid agencies, take action to improve the value of their health care dollars.

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