Lessons from the Oregon Health Insurance Experiment

With the future of the Affordable Care Act (ACA) still in doubt despite the withdrawal of a Republican-backed replacement plan in late March, some states are considering expanding Medicaid to help lower-income residents afford healthcare.

At the HIMSS Pop Health Forum earlier this month, Harvard economist Katherine Baicker discussed the ramifications of Medicaid expansion and elaborated on findings from the Oregon Health Insurance Experiment, in which researchers leveraged the state’s health insurance lottery to conduct a randomized control trial that measured the impact of Medicaid coverage on enrollees.

The Oregon study shows that Medicaid coverage resulted in significantly more outpatient visits, hospitalizations, prescription medications, and emergency department visits.

“People who have Medicaid use more healthcare, and that’s a good thing in terms of their access to care,” Baicker says. “People who got access to Medicaid were in better health according to their own reports, they had much lower rates of depression, their financial circumstances were much better, and they were less likely to have bills sent to collection or not be able to pay their other bills because of medical expenses.”

But, she adds, “that means expanding Medicaid comes with a real cost. People use more care, and you have to find a way to pay for it.”

While Medicaid access improved the financial and emotional well-being of Oregon enrollees, Baicker says, “we didn’t see any improvements that we could detect in high blood pressure, high cholesterol, or diabetes, so it’s a bit of a nuanced story in terms of the health effects. There were major improvements in depression, but less observable effects of physical health.”

In this video, Baicker also discusses what she sees as the two main goals of healthcare reform and how public policy can play a role in improving healthcare delivery.

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