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In his defense of the Republican Senate health care proposal, Heritage Action for America CEO Michael Needham argued that some patients on Medicaid are more likely to die than those without insurance.
Needham, who heads up the conservative organization, questioned the effectiveness of Medicaid in an interview on Fox News Sunday June 25.
"If the Democratic Party wants to become the party of Medicaid, I don't think it's going to have a lot of success in the 21st century. Medicaid was a program designed in the middle of the last century where health outcomes between people on Medicaid and the completely uninsured are exactly the same. Actually, on some procedures, you're more likely to die if you're on Medicaid than if you're uninsured," Needham said.
Legislation in both the House and Senate would slow the rate of Medicaid spending and result in enrollment declines, according to the Congressional Budget Office.
A spokesman for Needham said his statement about deaths for those on Medicaid compared with the uninsured came from a 2011 Wall Street Journal op-ed by Scott Gottlieb, who was recently confirmed as FDA commissioner. Gottlieb was also a clinical assistant professor at the New York University School of Medicine and a resident fellow at the conservative American Enterprise Institute.
Gottlieb wrote that for Medicaid patients, "in some cases, they’d do just as well without health insurance."
He cited four studies about the outcomes of patients on Medicaid for certain types of procedures. We were able to reach the authors of three of those studies, and they disputed Gottlieb’s conclusions.
University of Virginia study was only about people who underwent surgery
The largest study, done by the University of Virginia and published in 2010, followed the patient outcomes of almost 900,000 major surgeries across the country.
The study kept track of whether those patients had private insurance, Medicare, Medicaid or no insurance at all.
The results showed Medicaid patients were more likely to die following a procedure than the uninsured, but the deaths result from the fact that Medicaid patients tend to begin treatment in poorer health. That's a critical distinction, said one of the key researchers for the study, Dr. Irving Kron, a University of Virginia School of Medicine professor and cardiovascular surgeon. Kron told PolitiFact that Needham’s conclusion is incorrect.
Kron has said that his study doesn’t mean Medicaid is to blame for higher odds of patient deaths.
While the study adjusts for socioeconomic factors, it notes that if you’re on Medicaid, you’re probably suffering from a long list of risk factors other patients don’t have. Medicaid recipients are the poorest, least educated and sickest of all patients. Those patients have the highest incidence of AIDS, depression, liver disease, neurologic disorders, psychoses and metastatic cancer, according to the study.
"The reality is it’s apples and oranges," Kron previously 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."
Some other studies were narrow in scope
Gottlieb’s op-ed also cited studies examining outcomes for Medicaid patients who had cancer of the throat, coronary angioplasty or lung transplants. We tracked down authors of two of the studies; they rejected Gottlieb’s conclusions.
Gottlieb cited a 2010 study of 1,231 patients with cancer of the throat, published in the medical journal Cancer. The study found that Medicaid patients and people lacking any health insurance were both 50 percent more likely to die when compared with privately insured patients—even after adjusting for factors that influence cancer outcomes, Gottlieb wrote.
However, the authors of that report told PolitiFact that Gottlieb’s conclusion was wrong.
One of the caveats of the insurance records used for this study was that no distinction was made between patients who were covered by Medicaid at the time of diagnosis and those who were uninsured at diagnosis but were then enrolled in Medicaid, said Scott M. Langevin, an assistant professor in the Department of Environmental Health University of Cincinnati College of Medicine.
Since researchers were unable to consider the Medicaid and uninsured groups separately, it’s an "errant interpretation" to conclude that health outcomes for people on Medicaid and those completely uninsured are exactly the same, Langevin said.
Gottlieb also cited a study about outcomes for patients who underwent coronary angioplasty (a procedure to open clogged heart arteries).
Dr. Michael Gaglia, associate professor of medicine at the University of New Mexico and an author of the 2011 study in the American Journal of Cardiology, said that Gottlieb ignores the full findings of his study and the broader picture about Medicaid.
For those younger than 65, the Medicaid patients fared a little better than those who were uninsured, he said.
He said that such arguments that having Medicaid is worse than not having insurance is "absurd."
"This implication that somehow you get worse care with an insurance plan -- Medicaid -- than you would by not having an insurance plan at all -- no coverage, just going to the ER for emergencies -- for most reasonable people that doesn’t make any sense," he said.
PolitiFact has previously found at least seven academic papers that detected a link between securing health insurance and a decline in mortality. In general, these papers present a stronger consensus that having insurance saves lives.
Harvard researchers recently wrote a piece summarizing the evidence on the effect of Medicaid or other insurance on mortality. Their review of the evidence concludes that insurance like Medicaid significantly reduces mortality relative to being uninsured, said Katherine Baicker, one of the authors. The researchers found that "coverage expansions significantly increase patients’ access to care and use of preventive care, primary care, chronic illness treatment, medications, and surgery. These increases appear to produce significant, multifaceted, and nuanced benefits to health."
Needham said, "Actually, on some procedures, you're more likely to die if you're on Medicaid than if you're uninsured."
Needham points to a 2011 op-ed that cited studies about the outcomes of patients on Medicaid for certain types of procedures. We were able to reach the authors of three of those studies who disputed Gottlieb’s conclusions.
We rate this claim Mostly False.
Congressional Budget Office, H.R. 1628, June 26, 2017
Wall Street Journal, "Medicaid Is Worse Than No Coverage at All," March 10, 2011
New England Journal of Medicine, "Health Insurance Coverage and Health — What the Recent Evidence Tells Us," June 21, 2017
Damien J. LaPar et. al, "Primary Payer Status Affects Mortality for Major Surgical Operations," (Annals of Surgery) April 6, 2011 2011
Michael A. Gaglia Jr. et al, "Effect of Insurance Type on Adverse Cardiac Events After Percutaneous Coronary Intervention," (The American Journal of Cardiology) March 1, 2011
J.G. Allen et al, "Insurance status is an independent predictor of long-term survival after lung transplantation in the United States" (Journal of Heart and Lung Transplantation), Jan. 30, 2011
Joseph Kwok et al, "The Impact of Health Insurance Status on the Survival of Patients With Head and Neck Cancer" (Cancer), January 2010
EJ Charles et al, "Impact of Medicaid Expansion on Cardiac Surgery Volume and Outcomes," May 26. 2017
PolitiFact Florida, "Florida U.S. Rep. Ted Yoho misleads on claim about Medicaid," March 31, 2017
Kaiser Family Foundation, "Data note: three findings about access to care and health outcomes in Medicaid,"March 23, 2017
Kaiser Family Foundation, "What is Medicaid’s impact on access to care, health outcomes, and quality of care? Setting the record straight on the evidence," Aug. 2, 2013
Kaiser Family Foundation, "The effects of Medicaid expansion on ACA: a review of the literature," Feb. 22, 2017
American Enterprise Institute, "Medicaid is worse than no coverage at all," March 10, 2011
PolitiFact, "Raul Labrador's claim that no one dies from lack of health care access: Pants on Fire," May 8, 2017
PolitiFact, "Charlie Crist says six Floridians die a day due to lack of Medicaid expansion," Feb. 12, 2014
PolitiFact, "Medicaid recipients '97 percent more likely to die' than privately insured, Corcoran says," April 22, 2015
PolitiFact, "Is a new study of Medicaid a game changer?"May 3, 2013
PolitiFact, "Ted Cruz says expanding Medicaid will "worsen health care options for the most vulnerable," April 8, 2013
Interview, Dan Holler, Heritage Action for America spokesman, June 26, 2017
Interview with Irving Kron, University of Virginia School of Medicine professor, June 26, 2017
Interview, Eric J. Charles, MD, University of Virginia general surgery resident, June 27, 2017
Interview, Katherine Baicker, professor of health economics in the Department of Health Policy and Management at Harvard University’s T.H. Chan School of Public Health, June 26, 2017
Interview, Scott M Langevin, assistant professor Department of Environmental Health University of Cincinnati College of Medicine, June 26, 2017
Interview, Emanuela Taioli, Professor, Population Health Science and Policy, and Thoracic Surgery and Director, Institute for Translational EpidemiologI Icahn Medical Institute, June 26, 2017
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