A recorded commentary by Jeffrey Bland, PhD, arguing that recent U.S. health‑care policy debates—specifically Senate efforts to rescind or cut back the Affordable Care Act and Medicaid expansion—are paradoxical and contradictory given evidence that Medicaid expansion improved health outcomes. Bland cites comparative studies (Kentucky, Arkansas, Texas) and peer‑reviewed articles (JAMA Internal Medicine, NEJM) showing that expanding coverage for low‑income adults increased preventive care, medication adherence, reduced chronic disease burden, and produced statistically significant health improvements.
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You know, we're in the throes of something that is extraordinarily important to really tens of millions, probably hundreds of millions Americans, which is our national health care policy. And abandoning my cautious nature for a moment, I'd like to really speak about my own personal opinion about what's going on, because it is so paradoxical and so internally contradictory that I really can't even understand it. So I'm really asking for you to help me to kind of rationalize what the heck is going on right now. I want to go to this most recent situation with Mitch McConnell, the leader of our Senate, pushing through, and I want to emphasize pushing through with political pressure, the vote to move forward with the rescinding of the Affordable Health Care act in the absence of any really clear plan as to what the alternative would be, other than the rumors that we get, obviously from the plan that was already passed by the House and the proposed plan that we've seen from the Senate, that the new substitute would remove literally millions and millions of people from health care through the constriction of Medicaid. So the real question is, what health advantage does the present ability to reach out to people of less financial opportunities for supportive health care provide in terms of health for our country? And is there something paradoxical about all of this debate that we should be aware of? And so I was reminded in my thinking that Mitch McConnell is a senior senator from the state of Kentucky, which then asks the question, what do we know about health in Kentucky? So if you're not familiar with that, let me just remind you that the trending of health, which is done annually kind of health assessment on a state by state basis around the United States, and ranking that, if I look back at statistics from 1990 to 2016, where the data is available, that the trending for where Kentucky as a state ranks in health is somewhere between 47th and 45th lowest in the country out of 50 states. And what is the reason for that? The reason for that is ostensibly because Kentucky has a very serious burden of what we consider reducible chronic disease, chronic disease associated with lifestyle principles. So you might ask the question, does increased accessibility to Medicaid have anything to do with the changing of the outcome of health in Kentucky? And ironically, Kentucky is one of the three states in which a study has been done to examine whether Medicaid expansion, which occurred under aha, would have any benefit on reducing the burden of unnecessary chronic disease. In fact, those three states included Kentucky and Arkansas and Texas. Kentucky expanded its Medicare, making it more accessible to people of low income. Arkansas either expanded their Medicare or allowed for new options of private insurance at lower cost and Texas did nothing. And so they compared health outcome of those three states to see if there was any advantage whatsoever that could be demonstrated in health outcome. And lo and behold, it was found out that it extended their healthcare coverage to people of lower socioeconomic capability, that there was a reduction in the use in chronic disease, improved use of preventive care, increasing medication adherence, and a general statistically significant improvement in health. Now that was so profound in its outcome that there are actually some very nice studies that were done by senior faculty at the Harvard School of Public Health. I'm now quoting from an article that appeared in JAMA Internal Medicine in October 2016 entitled Changes in Utilization in Health among Low Income Adults after Medicaid Expansion or Expanded Private Insurance. And what did they find? This is the result of the study or the intervention I described of the difference between Kentucky and and Arkansas and Texas. And they go on to show in this paper that lo and behold, among the three states that Kentucky and Arkansas that expanded coverage under AHA to lower income individuals had a statistically significant improvement in overall health versus a state, Texas that did not. They could say aside from the hype of coverage obtained, outcomes were similar. And the two states where alternative approach to expansion were allowed led to improved health of the average individual in the state. There are a number of other studies that have supported this same concept. Low income residents in three states view Medicaid as equal or better than private coverage. In a paper that was published in health affiliates in 2014. There's another New England Journal of Medicine paper in 2012, Mortality and Access to Care among Adults after State Medicaid Expansions under AHA showing again the improved health outcomes that occurred as a consequence. So here's Mitch McConnell, our leader in the Senate from the dominant party who is saying that we don't need to have expansion of Medicaid, that in fact what we need to do is cut back on those expenditures in a state that is ranking between 45th and and 47th in health outcomes in the country at large, in which the only time that it has really shown any significant improvement against against headway against this problem was when Medicaid was expanded to individuals of lower income, providing them an opportunity to have health care. What's wrong with this? What's going on here? Help me understand. I don't understand any of this. When we have data in hand that clearly shows that expansion of Medicaid into people of lower income capability will result in improved health and reduced burden of disease. It's unfathomable to me that this is still being argued. Help me understand. Thank you.
