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OpEd: Pulling Back the Curtain on Medicaid Expansion

By: State Senator Charles Schwertner, MD
By: State Senator Charles Schwertner, MD

The following is an opinion piece written by State Senator Charles Schwertner, who represents District 5, which covers most of the Brazos Valley :

The Patient Protection and Affordable Care Act was sold to the American people on the ambitious premise that it would improve the health of millions of Americans and save tens of thousands of lives through preventative care. However, a landmark study published last week in the New England Journal of Medicine has cast substantial doubt on this central claim of Obamacare.

In 2008, the state of Oregon decided to extend Medicaid eligibility to the same population group that Texas is now considering: low-income, able-bodied adults who are currently uninsured. Without the funding to expand coverage to everyone meeting that criteria, Oregon lawmakers devised a novel solution -- a randomly-selected lottery for qualified applicants. This lottery afforded an intriguing opportunity to conduct a large-scale, scientific survey comparing the 6,387 low-income adults newly enrolled in Medicaid with another 5,842 individuals who remained uninsured.

Though individuals enrolled in Medicaid utilized 35% more medical services and 15% more prescription drugs than the uninsured, the Oregon Health Insurance Experiment found that the Medicaid group's measurable health outcomes (such as blood pressure, cholesterol, and blood sugar levels) showed no statistically significant improvement when compared to the control group. More puzzling still, the study found no decline in emergency room visits and a 30% increase in overall hospital admissions.

Clearly, this counterintuitive outcome has raised a number of questions. The study would seem to suggest that in spite of increased access to preventative care and improved identification of individual health risks, the Medicaid group didn't take advantage of that knowledge to make the kind of lifestyle changes needed for any lasting improvement to one's health.

The inherent flaw of Obamacare is that an individual's health is, above all else, a matter of personal responsibility. No matter how well-intentioned, no law handed down from Austin or Washington can ever force a person to quit smoking, eat healthier, or exercise regularly. Each are personal choices left to the individual, and each plays a far greater role in determining individual health than insurance coverage ever will. This may come as a surprise (or at least a disappointment), but there is no magic bullet to improving one's health…it requires commitment, diligence, and self-control.

If providing comprehensive, preventative health care in Oregon resulted in increased utilization and cost but no corresponding improvement in actual health, then why would Texas expand its Medicaid program as well?

However, the news isn't all bad. Despite showing no measurable improvement in overall health, those covered by Medicaid suffered almost no catastrophic, out-of-pocket medical expenses over the study's two-year timeframe.

Which gets to the heart of what health insurance was originally intended to be: not all things to all people, but a safety net to guard against the crushing expense of a truly catastrophic medical emergency.

Let's think about this another way. All drivers in the state of Texas are required to carry automotive insurance. These plans are relatively affordable, generally carry high deductibles, and are designed as a financial safeguard against only the most serious auto accidents. Most Americans would never dream of billing their car insurance company for routine, low-cost auto maintenance, such as an oil change or tire rotation, but that's precisely what we've come to expect from our health insurance.

If Oregon has anything to teach Texas, it's that Medicaid expansion really shouldn't be a comprehensive, gold-plated health plan, but rather a low-cost, high-deductible system of emergency health coverage that focuses on the one thing we've actually proven we can change…keeping patients who suffer from a serious medical event from going broke as a result.

Try as it might, government will never be able to legislate personal responsibility. But what it can do, and should do, is form the kind of health care system that rewards personal responsibility and puts patients back in charge of their health care. Options such as variable benefit packages, copayments, health savings accounts, and high-deductible emergency care plans have a far greater potential to keep costs under control and keep patients out of bankruptcy.

However, the federal government won't allow Texas the flexibility to implement these solutions in our state's Medicaid plan. Rather than forcing a poorly-conceived expansion of our overburdened Medicaid program, Washington should give Texas the freedom to use these kinds of innovative approaches to provide real, sustainable relief to our state's uninsured.

We can solve the challenges facing our health care system, but a one-size-fits-all Medicaid solution just doesn’t fit Texas. We should learn from the lesson of Oregon, and realize that the government's role in health care should be as limited as possible and narrowly focused on improving the things we can change, rather than throwing more and more money at the things we never will.

Senator Charles Schwertner is a medical doctor serving his first term in the Texas Senate. Dr. Schwertner represents the citizens of Senate District 5, a ten-county region of Central and East Texas which includes Brazos, Freestone, Grimes, Leon, Limestone, Madison, Milam, Robertson, Walker and Williamson counties.


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