A new study from Oregon warns us not to expect much improvement in short-term health care outcomes from Medicaid expansion, but also shows that long-term health and financial stability for new Medicaid recipients appears to be on the upswing.
In 2008, Oregon’s decision to expand Medicaid created a wonderful natural experiment. By using a lottery system to expand Medicaid, Oregon randomly selected about a third of the almost 90,000 low-income residents who signed up for the waiting list to enroll in Medicaid. The expansion’s randomized selection created an excellent environment for a controlled study: there was no difference between the new Medicaid enrollees and the people who didn’t win the lottery.
In 2013 the Oregon Health Study Group collected data on everyone who joined the waitlist, and compared the health outcomes of people who were selected with people who weren’t. Specifically, the authors measured blood pressure, cholesterol, and blood sugar levels; depression screening; medication; and self-reported measures like health status and out-of-pocket spending.[i]
The authors found no effects on health measures like cholesterol and hypertension in the two years after implementation. But access to Medicaid did significantly increase the likelihood of a patient getting diabetes screening and medication, and increased use of health care services. The increased access also had a quick and significant financial impact.[ii]
If a goal of health insurance is to “provid[e] financial security by protecting people from catastrophic health care expenses if they become sick or injured,”[iii] then Oregon’s Medicaid expansion has already been highly effective.
The study found that “catastrophic expenditures, defined as out-of-pocket medical expenses exceeding 30 percent of income, were nearly eliminated…a relative reduction of more than 80 percent.”[iv]
Expanding Medicaid may not have short-term health effects, but insurance is about protecting people for the long-term. What’s exciting is how new Medicaid enrollees changed their health care behavior. In two years, low-income Oregon residents took advantage of their increased access to health care by visiting the doctor more and getting treated for things like diabetes. These lifestyle changes will have serious benefits for long-term health outcomes.
Those looking for a quick and easy solution may be disappointed, but if you are looking out for the long-term health and financial stability of hundreds of thousands of North Carolina families, then you’ve got a lot of reasons to be excited about the possibility of Medicaid expansion finally coming to the Tar Heel State.
[i] Katherine Baicker, Ph.D., Sarah L. Taubman, Sc.D., Heidi L. Allen, Ph.D., Mira Bernstein, Ph.D., Jonathan H. Gruber, Ph.D., Joseph P. Newhouse, Ph.D., Eric C. Schneider, M.D., Bill J. Wright, Ph.D., Alan M. Zaslavsky, Ph.D., and Amy N. Finkelstein, Ph.D. for the Oregon Health Study Group. (2013). The Oregon Experiment — Effects of Medicaid on Clinical Outcomes. The New England Journal of Medicine. Available at http://www.nejm.org/doi/pdf/10.1056/NEJMsa1212321
[ii] See note i.