Oregon's Lesson to the Nation: Medicaid Works

Chuck Sheketoff

Oregon has set the health policy world abuzz once again.

A just-published study in the New England Journal of Medicine about the 2008 expansion of the Oregon Health Plan via a lottery system has generated a flurry of discussion about how expanding Medicaid impacts people’s health. This discussion is hardly academic, as states across the country are in the midst of planning or debating whether to expand their Medicaid program in response to the Affordable Care Act.

Oregon provided a unique opportunity to study the impact of Medicaid. In 2008, state officials decided to expand enrollment in the Oregon Health Plan, Oregon’s Medicaid program. Because the expansion could not cover all those eligible and wanting to get into program, the state conducted a lottery to determine who would be allowed in. The lottery created the conditions for a randomized control study to compare the outcomes for those who got insurance through Medicaid and those who remained uninsured.

What did the report find?

The following is a quick summary of the findings put together by Dr. Ashish Jha, a Harvard School of Public Health researcher familiar with the research report:

  1. People with Medicaid used more healthcare services – more doctor visits, more medications and even a few more ER visits and hospitalizations, though these last two were not statistically significant.
  2. People with Medicaid were more likely to get lots of tests – some of them probably good (cholesterol screening, Pap smears, mammograms) and some of them, probably bad (PSA tests).
  3. People with Medicaid, therefore, not surprisingly, spent more money on healthcare overall.
  4. People with Medicaid were less likely to go bankrupt due to healthcare expenditures.
  5. People with Medicaid had less depression and overall, had better health-related quality of life.
  6. People with Medicaid did not have meaningful improvements in their hypertension, cholesterol, diabetes, or other measures of overall health.

Although some critics of Medicaid have focused on the lack of improvements in some areas of health, others have noted that the data covers less than two years of access to health coverage. “We know that Oregon’s Medicaid recipients used more preventive care — a factor that may take years, or even decades, to show its full effect on their health,” explains Judy Solomon from the Center on Budget and Policy Priorities.

And what conclusions can be drawn? Medicaid works.

Both Dr. Jha and Ezra Klein from the Washington Post agree that the study confirms that Medicaid works as health insurance. The program makes it less likely for people to go bankrupt due to medical bills and gives the insured peace of mind and access to health care.

Yet both Dr. Jha and Klein stress that access to health care — whether through Medicaid or a private insurance plan — doesn’t necessarily mean access to quality health care.

In an effort to improve health outcomes, Governor Kitzhaber has set Oregon on a course of revamping the system for delivering health care to Oregon Health Plan members.

It will take time to know whether Oregon's "transformation" has improved health outcomes as envisioned by Governor Kitzhaber.

In the meantime, we do know that Medicaid works.

Oregon Center for Public PolicyChuck Sheketoff is the executive director of the Oregon Center for Public Policy. You can sign up to receive email notification of OCPP materials at www.ocpp.org.

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