Saturday, May 11, 2013

Oregon Medicaid Study

Just wanted to link to Tyler Cowen's terrific post on the Oregon Medicaid Study and provide a few thoughts of my own:
The key question here is how we should marginally revise our beliefs, or perhaps should have revised them all along (the results of this study are not actually so surprising, given other work on the efficacy of health insurance).  For instance should we revise health care policy toward greater emphasis on catastrophic care, or how about toward public health measures, or maybe cash transfers?  (I would say all three.)  One might even use this study to revise our views on what should be included in the ACA mandate, yet I haven’t heard a peep on that topic.  I am instead seeing a lot of efforts to distract our attention toward other questions.
I agree with his suggestions that health care policy should focus more on catastrophic care and public health.  I'm not sure how cash transfers would work, and I would like to see a study on that as well if possible.

As for actual measures by which the Affordable Care Act and our health care system should be modified in response to this, I have a couple of initial suggestions:

  1. A good first step might be to expand the catastrophic care provisions from young people (under ACA, only individuals 30 and under are allowed to buy catastrophic care plans) to a broader segment of the population.  
  2. We also might consider paring down the essential health benefits (EHBs), which require insurance companies to cover of a very large number of benefits.  If having more health insurance does not improve health outcomes, then it seems reasonable that our health insurance cover fewer benefits at the margins.  Substance abuse services and then preventive and wellness services would likely be the first EHBs on the chopping block.  

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