The challenge
Oregon could only afford Medicaid for a fraction of eligible low-income adults.
The case
In 2008 Oregon reopened Medicaid to low-income adults but could only fund about 10,000 places, so it held a lottery that about 90,000 people entered. Researchers compared lottery winners with non-winners. Over two years, coverage increased use of primary care, prescriptions and hospitals, nearly eliminated catastrophic medical bills, and substantially reduced depression. But it produced no statistically significant improvement in measured blood pressure, cholesterol or blood sugar, and emergency room visits went up by about 40% rather than down. Medicaid coverage lowered the probability of screening positive for depression by 9.15 percentage points, the researchers reported in the New England Journal of Medicine.
Why the results were mixed
Insurance clearly protects people's finances and mental health, but it did not quickly improve physical health or reduce ER use, as many had expected. A fair way of rationing scarce places also produced high-quality evidence.
Sources
- Baicker, K., et al. (2013). The Oregon Experiment: effects of Medicaid on clinical outcomes. New England Journal of Medicine.
- Taubman, S., et al. (2014). Medicaid increases emergency-department use. Science.
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