So much venom has seeped into the health-care debate now that it would be a miracle if partisans were to agree there is merit in any idea the other side may put on the table. Take, for instance, how resolutely the Republican Party has disowned the conservative-inspired “individual mandate” and its personal-responsibility underpinnings. (Ordinarily, you’d think the highest compliment one political party could pay its rival would be for it to adopt and enact a seminal idea from the other side, as a Democratic White House did with the mandate.) So much for imitation being the sincerest form of flattery. Congressional Republicans have threatened yet another vote this week to repeal the Affordable Care Act, an action that has become tiresome posturing after two years.
We are working ourselves toward a stalemate on health care. The sour atmosphere means the prospects for breaking it are not good. There is nothing to suggest that if or when the tables are turned, Democrats will be any less inclined to throw roadblocks against any replacement Republicans might offer in their “Repeal and Replace” effort.
Not quite two weeks ago when the Supreme Court upheld the health-care law, individual mandate, health exchanges and all, it gave state governments a tempting option: It said they could decline the law’s requirement — along with the federal funding — to extend their Medicaid programs to uninsured adults earning up to 133 percent of the federal poverty level, beginning in 2014. In response, governors in a handful of states, among them Florida, Texas and Louisiana, have announced outright they will not participate in the Medicaid expansion. The majority, including Ohio, are hedging, reluctant to commit yet to expanding the program for low-income citizens.
One thing we hear often from lawmakers in this unending debate is that if the evidence is there that one policy or another benefits American citizens, they will do what is right by the people. Everybody is for evidence-based policymaking; and that’s a good thing. You take politicians at their word at great risk to your blood pressure, but short of a miracle, paying attention to the evidence may be the only way left to drain some of the partisan vitriol from the health-care debate and allow policymakers space for objectivity.
And here is where Oregon’s penchant for breaking new ground in health policy could come in handy for states on a quest for evidence. Recall that in 1994, Oregon launched the country’s only statewide experiment in ranking medical conditions and treatments on the basis of clinical effectiveness, using the information to decide which services it would pay for in the state’s Medicaid program, the Oregon Health Plan. The savings from the strict limitation on services helped finance expanded Medicaid coverage for thousands more poor Oregonians. Oregon also was first to legalize physician-assisted death with its Death with Dignity Act in 1997.
Oregon became a national laboratory in another way in 2008. With funding enough to pay for an additional 10,000 Medicaid clients, the state won approval from the Centers for Medicare and Medicaid to proceed with drawing names by lottery from a waiting list of nearly 90,000 applicants for coverage. Officials deemed a lottery the fairest method of filling the available slots.
Thus started a real-life randomized controlled study of the impact of access on the insured and uninsured. The research team for the project released its findings from the first year of the Oregon Health Insurance Experiment in July last year. Late last month, a New York Times article caught up with some of the participants who won coverage by the luck of the draw and others on the waiting list who remain uninsured.
As governors and legislators finesse arguments for accepting or rejecting Medicaid expansion, they might pause to check in with Oregon’s experience. Among the key findings:
The newly insured are likely to use more services. Outpatient use went up by 35 percent and hospital admissions by 30 percent. Annual health expenditure is likely to rise as a result. Oregon’s rose 25 percent with the increased enrollment.
Enrollees were more likely to have a regular primary care physician or clinic and to follow recommended preventive care procedures. They assessed themselves in better health and were less likely to suffer depression. They were better off financially as well. They were 25 percent less likely to have unpaid medical bills sent to collection agencies, and 40 percent less likely to borrow money or skip payments on other bills because of medical expenses.
Two years of acrimony shows there are no easy answers. But if the aim is sound policy (and not political points), it is past time to cut out the noise and weigh the available facts.
Ofobike is the Beacon Journal chief editorial writer. She can be reached at 330-996-3513 or by email at lofobike@thebeaconjournal.com.
