A Real Medicaid Study

After a week of listening to conservatives demand the deepest respect for the social science findings of researchers looking at Medicaid in Oregon, Matt Yglesias has a very good idea:

The whole reason the Oregon study arose was that Oregon had enough money to give some additional people Medicaid benefits but not everyone. So they chose to run a lottery. A lottery is great from the viewpoint of experiment design, but the sample size here was tragically small. Meanwhile, the Florida legislature just refused to expand Medicaid to anyone even though the state’s Republican governor says he supports expansion. And Florida isn’t alone. Texas won’t be expanding Medicaid either. In fact, most of the deeply conservative states of the south and the plains won’t be expanding Medicaid. But these states—especially Texas and Florida—have much larger uninsured populations than smallish Oregon ever did. What’s more, the amount of money around to finance Medicaid expansion is really big. So if conservatives in Texas and Florida really want to get to the bottom of the whole Medicaid question, they now have a golden opportunity. They ought to apply for a waiver to get federal money to expand Medicaid to cover half the eligible population. Do a lottery, just like in Oregon. And do followup studies. That would give us a much larger sample and much stronger evidence.

Look at it this way, conservatives. You’re confident Medicaid is a really bad program that exhibits the worst features of the welfare state and turns the Sovereign States into agents of central government hegemony, right? So why not let the hated federal government pay for the definitive proof of Medicaid’s folly, which would save some big money in the long run? Yglesias’ snarky-sounding suggestion actually should be taken seriously as deserving a serious answer.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.