Op-ed: Medicaid Study

July 20, 2011

By Holly Taylor and Nancy Kass

Earlier this month, news outlets throughout the country reported on a study demonstrating that having medical insurance is beneficial to the poor. An expansion of Medicaid in Oregon allowed the state to randomly select 10,000 new recipients to their Medicaid program.  Researchers from MIT and Harvard, then, were able to measure the effect on health and well being of getting this coverage, compared to having no insurance whatsoever. This is a landmark study, and findings were dramatic. Those randomized to Medicaid coverage were 60 percent more likely to get a mammogram, significantly more likely to report being in good or excellent health, significantly less likely to report being depressed, and 40 percent less likely than those who didn’t get the coverage to be delinquent with other bills due to medical debt.


However, that such an experiment could be conducted with such an elegant, methodologically rigorous, randomized design also speaks to the paradoxes that exist in public policy in the United States—and in what may be the way we draw lines in the sand with regard to ethics and scientific discovery.


We have long known that access to health insurance is key to obtaining health care in the United States. As the thoughtful authors of the recent Medicaid study point out, literally hundreds of studies have been conducted previously that document the negative health effects of being uninsured or underinsured.  Indeed, one might assert that the 47 million Americans who lack health insurance have been part of a national observational study for decades, demonstrating higher rates of chronic diseases, later diagnoses, earlier mortality and lower quality of life.


Thus, conducting a new study that observes and measures the effects of having or not having insurance could only be proposed as a matter for continued scientific investigation in a country where so many of our elected officials still seem to view health insurance as a matter for political debate, rather than a responsibility to be assured for our citizens. It is perhaps for this reason that federal officials saw no irony in funding a project to measure scientifically what happens if we do or do not give people basic health coverage—and then we wait a year to watch what happens. One need only recall the maelstrom of ethical controversy that emerged more than a decade ago when poor countries in Africa and Asia wanted to test giving treatment to some randomly selected HIV-infected pregnant women as a possible means of preventing maternal-to-infant transmission, and compare it to outcomes among women given no medicines. The ethics debate, covered widely across many media outlets, focused on whether simply being from a poor country was grounds for being randomized to no care when HIV-infected women from wealthier countries were being given these medicines routinely to prevent their babies from becoming HIV infected. Some labeled these trials unethical on the grounds that they denied the women access to what was the highest standard of care available.


How ironic indeed that we have grown so accustomed to poor women, men and children in our own country going without care that no ethical maelstroms are raised when public officials and scientists want to compare what happens when a few of these people get the golden ticket and some basic health coverage, and compare them to the rest of the poor folks who weren’t so fortunate.


The women in Africa lucked out. The HIV interventions proved wildly successful, and the global community realized that the scientific evidence was too strong not to give them care. Given the budget rhetoric and political machinations going on, we fear such promise is likely to go unfulfilled in America.


Holly Taylor
, Ph.D., M.P.H., and Nancy Kass, Sc.D., are core faculty members of the Johns Hopkins Berman Institute of Bioethics.

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Holly Taylor
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2 Responses to “Op-ed: Medicaid Study”

  1. […] claim that it is ‘not an issue’ is cruel and just plain wrong. Let’s remember the findings of yet another study (a study of the obvious sort, that we ought not even need to conduct), showing that when […]

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