Smokers, drinkers on Medicaid? Quality care depends on knowing who your patients are

Gov. Paul Lepage, right, laughs as Paul Nickerson of Lewiston, a member of the Maine People's Alliance, interrupts a press conference at Central Maine Medical Center in Lewiston on Wednesday afternoon.
Russ Dillingham/Sun Journal
Gov. Paul Lepage, right, laughs as Paul Nickerson of Lewiston, a member of the Maine People's Alliance, interrupts a press conference at Central Maine Medical Center in Lewiston on Wednesday afternoon.
By Dr. Tammy Chang, Special to the BDN
Posted Sept. 23, 2013, at 11:27 a.m.

Should states expand Medicaid under the Affordable Care Act? Maine has wrestled with this question, as have many states. The answer to this question reflects both policy and politics — which can vary considerably from state to state.

As a primary care doctor and health policy researcher, I recently published a paper to shed light on the policy question at the heart of the matter: Will expanding Medicaid help more than it hurts, or hurt more than it helps? Last week, Gov. Paul LePage interpreted the research study in his public remarks, and as the lead author of that study I would like to clarify several statements that have been circulating ever since.

The study, published in the Annals of Family Medicine by coauthor Dr. Matthew Davis and me, describes the characteristics of Americans potentially eligible for the Medicaid expansion under the Affordable Care Act.

Using a national source of data used by many other researchers who look at national trends, such as high blood pressure and obesity, we illustrated that these potential new Medicaid enrollees on average are just as healthy, if not healthier, than the current Medicaid population. In contrast, they will have higher rates of current smoking and heavy drinking than people currently on Medicaid. These new enrollees will also likely be younger, with more males, and more white than black individuals.

We concluded that providing affordable health care for these uninsured, poor and low-income Americans is a key opportunity to keep people healthy and prevent future health problems related to smoking and heavy drinking. Helping people with unhealthy habits today can address the high costs of health care in the U.S. by preventing life-threatening, expensive diseases in the future.

A natural question about our research is: How do these findings apply to Maine? After all, Maine has a higher-than-average proportion of residents already enrolled in Medicaid (31 percent, compared with the national average of 21 percent). Higher enrollment rates can make policymakers cautious about program expansion.

LePage alluded to such concerns in his statements, saying that a Medicaid expansion would “provide services to a younger population,” while depleting resources for “the elderly and disabled.” The age and disability-related concerns that LePage raised are not part of our study, however. In fact, we did not consider the elderly in our study because more than 99 percent of seniors (including Mainers) already have coverage through Medicare.

It is essential for me to emphasize that our study does not and cannot show how states should implement their individual Medicaid programs, or decide who will receive coverage. States work directly with the federal government on such matters. As a family physician and policy researcher, my goal in publishing this study was to contribute helpful information to inform the current discussion around Medicaid expansion. This is what I tell patients about what we found:

1. We learned who will benefit from Medicaid expansion. Recent studies have found that the majority of the uninsured say they don’t have enough information about how health care reform will affect them. In states that expand Medicaid, millions more low-income and uninsured individuals will have access to affordable health care. What our study adds is that on average this population will be younger, with more male and white individuals when compared with the current Medicaid population.

2. We can help physicians provide the best possible care to this population of new Medicaid patients. Health systems, health centers and physicians will need to work together to provide care for new Medicaid enrollees. This begins with an accurate understanding of these individuals and their health needs. Focusing on prevention as people get new health care coverage and potentially reducing the long-term effects of poor health habits could help reduce the costs of Medicare for all taxpayers in the future as these patients grow older.

3. We can help policymakers make the best decisions for the health and well-being of the people they serve. For states that have approved Medicaid expansion as well as for undecided states like Maine, policymakers need information about who is at stake and how this expanded health coverage might impact these individuals.

We hope that those who cite our research will represent it as accurately as we have sought to present our findings. Mainers, like all Americans, deserve the opportunity to talk about key policy issues at the state and federal level with the facts in hand.

Dr. Tammy Chang is an assistant professor in the Department of Family Medicine at the University of Michigan and a practicing physician at the Ypsilanti Health Center, part of the University of Michigan Health System.

http://bangordailynews.com/2013/09/23/opinion/smokers-drinkers-on-medicaid-quality-care-depends-on-knowing-who-your-patients-are/ printed on August 20, 2014