Our country is poised to take health coverage away from millions of low-income Americans largely based on the findings of a flawed and flagrantly misleading study.
President Trump’s budget reconciliation bill recently produced the largest cut to Medicaid health insurance in its 60-year history.
Claiming to reduce “fraud and abuse,” it will cut essential medical services for at least 12 million low-income people through unachievable work requirements, unaffordable out-of-pocket costs and inaccessible hospital and nursing home care.
This will likely have the unintended effect of causing thousands of excess deaths and hundreds of thousands of preventable hospitalizations among low-income people who will lose insurance coverage.
What has gone largely unreported during the debate and passage of the cut is that an untrustworthy study of Medicaid that asserted there was no improvement in physical health for those with Medicaid coverage.
This study has been cited by the Trump administration, Republican House leaders and the media as proof that taking away health care coverage will, in defiance of common sense, not damage the health of Americans.
But this 2013 study in the New England Journal of Medicine — the Oregon Health Insurance Experiment — misled rather than informed policymakers. The methods used were flawed. Just for starters, more than two-thirds of the study group were not, in fact, on Medicaid.
Bluntly, the findings of this study are useless for any scientific or policy purposes, especially to justify such major changes to Medicaid.
The study purported to show that Oregon’s expansion of its Medicaid program as part of the Affordable Care Act had failed to improve the physical health of its recipients. That conclusion was pounced on by ideologues attempting to derail the program’s expansion.
The Oregon study’s results have been touted by the Heritage Foundation, whose Project 2025 included deep cuts in Medicaid funding. The Paragon Health Institute, an influential policy research center led by former Trump officials, also relied on the Oregon study to conclude, falsely, that health insurance has almost no effect on physiological health like blood pressure and diabetes control.
The Economist, Forbes, The Wall Street Journal and many other publications, have cited this same study as a rationale for cuts to Medicaid.
But not only is the study not what its ideological proponents say it is, it is not what the authors of the study claim it to be — the only randomized controlled trial of Medicaid insurance.
First, it is clearly not a randomized controlled study of anything. The researchers used a lottery to determine who would and would not be offered Medicaid from a wait list in an urban area of Oregon.
In theory, this might have worked. But information buried in the study’s supplementary appendix shows that an unacceptably high 70 percent of those “randomly” assigned to the “offer” of Medicaid were ineligible for Medicaid because their income was too high or they did not properly fill out the required paperwork.
Despite this, throughout the study’s results, the authors described the 70 percent who never got Medicaid as “Medicaid recipients.” This misleading assertion is akin to a drug trial in which 7 out of 10 people randomized to the study drug never actually received the drug.
The overwhelming evidence shows that Medicaid coverage does matter for the poor and chronically ill. A convincing landmark study showed that life-threatening illnesses worsened after Medicaid was withdrawn from medically indigent people in California.
Reduced drug insurance coverage among those covered by Medicaid with chronic diseases such as diabetes, heart disease and mental illness led to the discontinuation of life-saving medications.
This resulted in an increase in costly emergency hospitalizations and permanent institutionalizations in nursing homes — both at far greater costs than the miniscule savings to Medicaid.
Faulty science can lead to long-lasting harms for public health. This flawed study continues to be cited in thousands of media articles, frequently to promote or justify cuts in Medicaid coverage for millions of vulnerable citizens. In fact, it is now a go-to rationale for politicians who want to take health care away from the most vulnerable.
The human toll of this cut, based in very large part on bad information, is going to be widespread and deep. This debate is not anywhere near over. We as a society, and as medical professionals, are going to be revisiting this potential disaster as it unfolds.
A crucial part of that is understanding that assumptions made by the Trump administration, much of the media and the architects of Project 2025, were based on bad information.
Stephen Soumerai and Gordon Moore are professors at Harvard Medical School.
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