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August 16 2016

ObamaCare Supporters Are Leaping on a Flawed Survey

Patrice L. Onwuka

The New York Times and a flurry of other news outlets were quick to latch onto a new study that seems to suggest ObamaCare’s Medicaid expansion is making Americans healthier, but the devil is in the details or lack thereof.

ObamaCare has given people healthcare insurance, but has it made them any healthier? After all, what good is a plastic card, if you still don’t have access to quality care?

The study is from JAMA Internal Medicine and, at first glance, appears to uphold the idea that newly covered people tend to pursue preventative care and have lower medical debt. They reportedly also tend to report better health.

The report in fact painted a glowing picture of health care in states that had expanded Medicaid.  Sounds great, right?  

While supporters have been quick to tout the results, the report is flawed in important ways: first of all, it’s based upon self-reporting and people give the responses they think researchers are aiming for on such surveys. Response bias is the tendency for a person to answer questions on a survey untruthfully or misleadingly. For example, people lie on surveys about how much they weigh and their height – either underreporting or over-reporting. In this case, respondents likely know that researchers are relying on those with coverage to report how much better their health is with Medicaid coverage.

The Obama Administration has been masterful in using dubiously achieved statistics to promote its agenda.  

Even the New York Times admits this bias. The newspaper acknowledges that people with healthcare coverage are more likely say they are in better health than those without, despite whether there is data to back that up:

It might sound simple to measure whether people are healthier than they used to be, but it’s actually pretty tough. While tests can tell you whether someone has high cholesterol, say, or high blood pressure, a single test may not tell the whole story. It turns out, however, that if you ask people how healthy they are, they do a pretty good job of telling you. Extensive research shows that people who say they are in poor health really are much more likely to die soon than those who describe their health as good.

A famous experiment of low-income people in Oregon tracked one group that won a lottery to receive Medicaid coverage and another that remained uninsured. That study found that people who got insurance were much more likely than their uninsured peers to describe themselves as having good or excellent health. People who got health insurance in that experiment were also more financially secure. But the experiment did not show big changes in some key physical health measures in people they studied, like blood pressure and cholesterol.

The second major flaw of the survey is that it confuses having health insurance with actual medical services. However, what about actual evidence of better health? Do they have lower cholesterol? Were diseases caught early? These are the outcomes of healthcare coverage that policymakers should be asking about rather than who has done the paperwork to get coverage. It would take a more in-depth survey to answer these questions.  

Americans want to be healthy and those who can’t afford healthcare on their own need more than a plastic card granting them access to a complex healthcare bureaucracy, they need quality care that leads to better outcomes. We don’t know if people are receiving the care they need, are able to more easily find doctors to accept their insurance or to provide the services they need. It is things like these and not a plastic card that make people healthier.

IIndependent Women's Forum is an educational 501(c)(3) dedicated to developing and advancing policies that aren’t just well intended, but actually enhance people’s freedom, choices, and opportunities. IWF is the sister organization of the Independent Women’s Voice.​
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