Is Obamacare Helping Anyone Stay Healthy?

by Brian T. Lynch, MSW

Let's say you really want to know if Obamacare has had a positive effects on keeping people healthy. Partisan politics makes it difficult to get any concrete or objective answers to this or any questions regarding the Affordable Care Act (ACA). So how would you go about finding the answer?

You could find out by designing your own study. You might start by looking at diseases that are silent killers because these have permanently damaging effects long before there are physical symptoms.

Diabetes is just such a disease. According to medical sources, as many as one person in four have diabetes and don't know it. The longer it goes undetected the more it damages your internal organs, yet a simple blood test and doctors visit is all it takes to uncover and control this disease.

Now imagine that you have results of 400,000 diabetes blood tests nationwide from which you could pull out all the newly diagnosed cases. First you sort the new case in 2013, before any Medicaid expansion, from the 2014 cases after the expansion. Next you sort the new diabetes cases from each period by the 26 states that expanded Medicaid from the 24 states that refused. A concrete measure of an improved healthcare outcome would be finding that there was an increased rate of diabetes detection in the expansion states over the non-expansion states.

Just such a study was done and published this week (March 21, 2015) by Qwest Diagnostics, a national medical laboratory. What their analysis discovered was a 23% increase of newly diagnosed cases of diabetes in the states that expanded Medicaid in 2014. There was only a 0.4% increase in new diabetes cases from states that did not expand Medicaid. What's more, they were able to see a trend towards earlier detection of diabetes in the expansion states. Earlier detection means fewer heart attacks, strokes, kidney transplants, amputations, blindness and premature deaths. This, in turn, means a healthier population and lower health care costs over time.

Thousands of people will now lead healthier lives and live to their full potent in those 26 states that expanded Medicaid under the ACA. The number of people who could have been covered by the expansion roughly equals the number who got coverage in 2014. This means an almost equal number of people will likely experience needlessly declining health due to undiagnosed diabetes. The states that don't expand Medicaid will have higher healthcare costs in the future resulting from a less healthy population.

The news isn't all bleak for the poor or elderly in states that didn't expand Medicaid. A report by the Avalere Health organization recently found that there are 550,000 new enrollees in standard Medicaid in 15 states that have not expanded Medicaid. They attribute this rise in enrollment to the "woodwork effect," caused by increased public awareness and publicity surrounding Obamacare. These are individuals who were eligible for standard Medicaid but hadn't applied. It is safe to presume that some of them will benefit from the early detection of diabetes.

From this one Quest diagnostics study alone the answer is clear. The Affordable Care Act is having a positive effect on the health and well-being of citizens in those states that expanded Medicaid. There are other silent killers that can easily be detected early while treatments and cures are still possible, such as high blood pressure and many types of cancer. If earlier detection of these diseases are also resulting from Medicaid expansion, this would be overwhelming evidence that the ACA is improving health outcomes.

Expanding Medicaid doesn't cost the states any additional revenue for the first few years. After that there is significant reimbursements from the Federal Government. Refusing Medicaid expansion actually costs states millions of dollars in uncompensated care right now. Doing this on ideological grounds is not a principled position, not when it clearly results in a less healthy population and increased medical expenses for the foreseeable future.

I close with a quote from the actual Quest Diagnostics study findings:

Actual Study Findings:

"We identified 215,398 and 218,890 patients who met our definition of newly diagnosed diabetes within the first 6 months of 2013 (control period) and 2014 (study period), respectively (a 1.6% increase). We identified 26,237 Medicaid enrolled patients with new diabetes in the control period vs. 29,673 in the study period: an increase of 13%. The number of Medicaid-enrolled patients with newly identified diabetes increased by 23% (14,625 vs. 18,020 patients) in the 26 states (and District of Columbia) that expanded Medicaid compared with an increase of 0.4% (11,612 vs. 11,653 patients) in the 24 states that did not expand Medicaid during this period. Similar differences were observed in younger and older adults and for both men and women."

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Quest Diagnostics Diabetes Study: http://care.diabetesjournals.org/content/early/2015/03/19/dc14-2334.full.pdf+html

Avalere Health Report: http://avalere.com/expertise/managed-care/insights/avalere-analysis-medicaid-non-expansion-states-experience-up-to-10-enrollme