What is an Investment?

Spencer and his team talk a lot about investments in public and through the Capitol Corner blog.  Spencer has talked frequently about investments related to Pre-K education.  We’ve noted that the state budget is an investment in our priorities.  Over the life of the website, we’ve mentioned the term more than 80 times.

But what do we mean when we say investment, and what does that look like in reality?  A recent study on the expansion of the Medicaid program three decades ago provides some understanding.

In the early 1980’s, the United States had an infant mortality rate of 13 deaths per 1,000 births, ranked 20th in the world.  This high rate motivated a bipartisan coalition of lawmakers to pursue policies that would expand health care access to low-income pregnant women and their young children by expanding the Medicaid program.  These expansions took place in nine laws between 1984 and 1997, seven of which were signed by Presidents Ronald Reagan and George H.W. Bush.

A July study by researchers at the University of Michigan took a long-term look at the impact of those new policies.  To do so, they looked at the health of present day adults who were in their mother’s womb when their mother became eligible for newly-expanded Medicaid.  They found that positive health impacts were seen when those children were born and lasted into the child’s adult life.

Their data shows that a ten percentage point increase in Medicaid eligibility for pregnant women decreased the chance that their now-adult children would be obese by seven percent, reduced preventable hospitalizations by seven percent, and reduced chronic illness related preventable hospitalizations by nine percent.  Medicaid coverage later in childhood also reduced the chance of being obese or hospitalized later in life, but the most dramatic impacts were seen for the unborn children whose mothers gained coverage.

The researchers also found that the use of healthcare services amongst this group was significantly diminished in the long-run due to better health, further supporting the notion that access to health care and better health can result in long-run cost savings over being uninsured.

This study captures something that can be difficult to capture in research: the dividend on a long-term public policy investment.  Their work suggests that a very specific group of people who were the targeted beneficiaries of a public policy decision almost 30 years ago are in better health now because of that policy intervention.  Their better health is the dividend to our public investment.

In recent political battles over health care, education, and other smart investments, insufficient attention has been paid to the long-run consequences of policy decisions.  Our state legislature should work to correct this by passing policies that make Georgia better in the long run.  We should expand our Medicaid program so that people who have chronic illnesses like diabetes can receive treatment and go back to work.  We should protect programs like SNAP which show similar long term benefits as children grow into adults.  We should also monitor the progress of these investments over the long run and decide if they were the right thing to do.  If they turn out to not be effective, we should adjust them to ensure that they are.  Anything less than an approach like this will sell Georgia short in the long run.

Related:  What is Medicaid?

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