The following is a guest blog post from Trudy Lieberman, one of our contributors.
When the Florida legislature recently adjourned without expanding Medicaid after contentious debate, one statement by Rep. Richard Corcoran undoubtedly influenced the outcome. When Corcoran’s constituents emailed him asking for Medicaid expansion, he replied:
“The largest national study, conducted by the University of Virginia, found that Medicaid patients were 97% more likely to die than those with private insurance.”
Really? That makes it sound like the whole program ought to be scrapped because Medicaid benefits are likely to kill the 65 million or so Americans who depend on them for their healthcare. How many constituents would favor expansion after reading that? (The Affordable Care Act called for all states to expand their Medicaid programs, but the Supreme Court gave them the option. So far 22 have refused.)
Corcoran’s provocative comment certainly deserved media scrutiny. He was twisting results of a study to advance a political agenda. In my view a politician making such a sweeping, questionable remark is no different from a drug or device company making a claim based on flimsy evidence. Lately we’ve been trying harder as journalists to dig behind the medical claims. But when it comes to challenging such claims in the health policy world, not so much. Except for PolitiFact’s critique published in the Tampa Bay Times, our search of Florida’s media turned up no other stories dissecting Corcoran’s response to his constituents.
PolitiFact spoke to one of the study authors who said it was a misleading statistic. The University of Virginia study published in 2010 examined 900,000 surgery cases across the U.S. and followed patient outcomes. For starters, it examined patients with all kinds of insurance not just coverage from Medicaid, and some had no insurance. Researchers then adjusted for patient health and other variables like age and income. Yes, they did find that Medicaid patients were 1.97 times more likely to die following a procedure than patients with private insurance. From that number Corcoran concluded Medicaid was a bad program because recipients were 97 percent more likely to die.
Here’s where the need for skepticism—and truth—come in. Did that mean Medicaid is the reason patients had higher mortality rates? Not so fast. One of the researchers pointed out that Medicaid patients usually have a whole bunch of risk factors that may have contributed to the poorer outcomes. People on Medicaid are likely to be sicker, poorer, and the least educated, and we know both higher income and more education correlate with better health. Dr. Irving Kron, a heart surgeon and University of Virginia professor, told PolitiFact “the problem with Medicaid is there’s more emergencies because they’re sicker than most people…They wait for care and unfortunately, emergent patients don’t do as well as elective patients.”
In other words, being on Medicaid was not the reason for their poorer outcomes. “Corcoran’s statement implying that Medicaid is the cause of higher mortality is just wrong,” My fellow HealthNewsReview contributor Andrew Holtz told me. “Journalists should have looked up the study and found it did not say Medicaid causes higher mortality.”
The study also found that patients without insurance had worse outcomes. They were 74 percent more likely to die than those with private insurance who researchers found had the best outcomes. “Researchers said insurance status could be a good proxy for socio-economic problems in peoples’ lives,” Holtz noted.
Researchers did not investigate the quality of care given to people under the Medicaid program although Corcoran’s constituents and others could easily jump to that conclusion. We know that healthcare quality and safety problems plague the entire health system, also a point that would have been worth a journalist’s look in the context of Corcoran’s statement.
When PolitiFact discussed the study with Corcoran, he insisted the University of Virginia study supported his conclusion. “My point was that Medicaid is a subpar healthcare delivery system,” he said.
There’s nothing new about politicians making outlandish claims, but now they increasingly appear in health policy debates. What’s needed more than ever in the face of such unwillingness to use evidence correctly is a lot more journalists and news outlets willing to push back and set the record straight.