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Invited Commentary
November 11, 2019

Public Comments and Industry Interests in Medicaid Coverage Decisions

Author Affiliations
  • 1Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania
  • 2Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
JAMA Intern Med. Published online November 11, 2019. doi:https://doi.org/10.1001/jamainternmed.2019.5077

In this issue of JAMA Internal Medicine, Ahn et al1 raise the intriguing question of whether treatments covered by Medicaid should be democratically decided. Analyzing Oregon and Washington state guidance documents for proposed Medicaid coverage, and the public comments responding to these documents, Ahn et al1 found that 88% of commenters supported expanding coverage to include additional treatments and that at least 40% of commenters had financial ties to companies making products affected by the coverage decision. Yet the evidence cited in support of coverage was weak: almost 80% of commenters cited no studies, and even when cited, fewer than one-third of the studies that were referenced were randomized clinical trials. The authors thus document public comments that are skewed toward expanding coverage, clouded by industry interests, and impaired by weak supporting evidence.

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