In GOP Convention’s Shadow, Obamacare Is Paying Big Dividends

Behavioral health is one area in which the clinic can do a lot more than it could before, thanks to newly hired therapists and, for the first time, a room dedicated exclusively to counseling and psychiatric consultations.

Wellness has been another priority. Today the clinic offers parenting training for pregnant women and new mothers, as well as classes for all patients on nutrition and cooking. The hope is to reach people with conditions like diabetes and teach them to manage their conditions better, thereby minimizing or avoiding altogether the complications that would lead to costly treatment later.

Megan Meister, director of community engagement, described one patient who had multiple chronic conditions, including diabetes, but has participated in some of the wellness initiatives and come in for regular preventive care. According to Meister, the patient’s blood glucose levels and weight are both down. “So she’s taking less medication, and she’s less likely to go to the ER. That saves taxpayers money.”

Anecdotes like that obviously don’t prove that better preventive care and other benefits of Medicaid expansion will actually reduce what the government, or society as a whole, spends on health care. Past efforts along those lines have frequently been fruitless. But an assessment of an early version of Medicaid expansion in Ohio suggested that, if patients are part of an integrated system with clinics and hospitals, spending more upfront to keep people healthy ends up costing no more money, and maybe a little less, over the long run.

Medicaid expansion’s effects on the people who enroll is less ambiguous. Conservative critics like to point out that many specialists won’t take Medicaid patients, because the reimbursement levels are so low. Some critics have even argued that, overall, Medicaid leaves people worse off than if they had no insurance at all. But research has shown that the program, despite its real flaws, leaves people better off financially and, possibly, healthier as well.

That research on Medicaid comes from all over the country, with the most influential new studies arriving from Massachusetts and Oregon. As for Ohio, Kauffman said, patients certainly appear to be better off ? particularly those middle-aged patients who, prior to expansion, would lose coverage and have no way to regain it before Medicare kicked in.

“You have people in their 50s or 60s,” Kauffman explained. “They fell out of the workforce ? maybe they didn’t keep up their skills or they got bad knees, though not bad enough to get disability [insurance]. … You have people who are functional, stable citizens whose lives are falling apart. It’s heartbreaking. But with Medicaid they can get their lives back on track, get back to work.”