Friday, July 31, 2015

New Evidence That Obamacare is Working?

Obamacare supporters are excited by a research article suggesting Obamacare is working to increase access to care. In an article published in JAMA: The Journal of the American Medical Association, researchers followed up respondents to the Gallup-Healthways Well-Being Index (which I’ve discussed previously.)

Yes, in an absolute sense, their access to care improved. According to the Huffington Post’s Jonathan Cohn, this means “Another Argument From Obamacare Critics Is Starting To Crumble.”

Oh dear. Even Citizen Cohn admits “The picture from the raw data is a little muddled” and “like all academic studies, this one will be subject to scrutiny that, over time, could call its findings into question.” Well, I won’t call them into question, just point out what is obvious from the abstract itself: Obamacare is dong a terrible job increasing access to care.

Here is the abstract (from which I have deleted the confidence intervals reported in the abstract to make it easier to read):
Among the 507 055 adults in this survey, pre-ACA trends were significantly worsening for all outcomes. Compared with the pre-ACA trends, by the first quarter of 2015, the adjusted proportions who were uninsured decreased by 7.9 percentage points; who lacked a personal physician, −3.5 percentage points; who lacked easy access to medicine, −2.4 percentage points; who were unable to afford care, −5.5 percentage points; who reported fair/poor health, −3.4 percentage points; and the percentage of days with activities limited by health, −1.7 percentage points. Coverage changes were largest among minorities; for example, the decrease in the uninsured rate was larger among Latino adults (−11.9 percentage points than white adults. Medicaid expansion was associated with significant reductions among low-income adults in the uninsured rate (differences-in-differences estimate, −5.2 percentage points), lacking a personal physician (−1.8 percentage points), and difficulty accessing medicine (−2.2 percentage points). 
B.D. Sommers, et al., “Changes in Self-Reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act, JAMA: The Journal of the American Medical Association, 314:4 (July 28, 2015)
The uninsured dropped by 7.9 percentage points, but those who lacked a personal physician dropped only 3.5 percentage points. In other words, 56 percent of those who got insurance under Obamacare still lack access to a personal physician. With respect to Medicaid, it was worse. The number of Medicaid dependents dropped 5.2 percentage points but the number lacking a personal physician only dropped 1.8 percentage points. That means 65 percent of those newly enrolled in Medicaid still lack a personal physician.

That does not look like success to me. It looks like spending a whole lot of money for little result.

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