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Another nail in the Medicaid coffin

Published by digby on May 6, 2013

Another nail in the Medicaid coffin

by digby

Well, I guess this was predictable:

That’s pretty much what I’s seeing all across the blogosphere today. And I’m going to guess that the conservatives will continue to use this Oregon study as an excuse to cut Medicaid funding for some time to come, with the acquiescence of Democrats who are all to eager to sign on to “efficient” and “pragmatic” arguments against anything that makes them feel like a hippie.

But it turns out the study they are all quoting with such glee was badly designed and couldn’t have shown, one way or the other, what they were seeking to find. Kevin Drum does a nice analysis of the data and concludes this:

[W]hat’s a fair thing to say about the results of this study?

One fair thing would be to simply say that it’s inconclusive, full stop. It tells us nothing about the effect of Medicaid access on diabetes, cholesterol levels, or blood pressure maintenance. I’m fine with that interpretation.

Another fair thing would be to say that the results were positive, but the study was simply to small to tell us if the results are real.

Or there’s a third fair thing you could say: From a Bayesian perspective, the Oregon results should slightly increase our belief that access to Medicaid produces positive results for diabetes, cholesterol levels, and blood pressure maintenance. It shouldn’t increase our belief much, but if you toss the positive point estimates into the stew of everything we already know, they add slightly to our prior belief that Medicaid is effective.

But you can’t say that the results are disappointing, at least not without a lot of caveats. At a minimum, the bare fact that the results aren’t statistically significant certainly can’t be described as a disappointment. That was baked into the cake from the beginning. This study was never likely to find significant results in the first place.

So that’s that. You can’t honestly say that the study shows that Medicaid “seemed to have little or no impact on common medical conditions like hypertension and diabetes.” That just isn’t what it showed.

Keep your eye on the Village gasbags over the next few days. If the Ruth Marcus-David Brooks nexus gloms onto this study, we’ll know that this has hit the centrist sweet-spot already.

The Medicaid expansion along with the ban on pre-existing conditions exclusion was always the most compelling part of Obamacare from a liberal perspective. It was a badly needed expansion of government provided, single payer health care for the working poor and it was supposed to cover a very large number of people in our growing underclass. But because it covered the working poor, it was always going to be subject to cutting and slashing either in big chunks or through incremental cuts over the course of many years. The Democrats who were supposed to protect it have shown that they are willing to trade it away for other things “they like”, as the president likes to term it. (As if what Democratic politicians “like” is the same thing as what average citizens “need.”)

And so it begins. I had been hopeful that the Obama administration would do everything it could to protect its signature achievement and would therefore protect Medicaid as a huge part of it —after all,  it was supposed to end up covering more than 20 million people. The budget negotiations have shown otherwise, which means that they really define Obamacare as the new regulations, the mandate and the exchanges, which is fair enough. But the Medicaid expansion was the liberal heart of Obamacare and the reason why so many progressives in congress were compelled to vote for it.

Now, it remains to be seen if they will fight for it.

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