Does Medicaid Make You Healthier? My Takeaways from the Oregon Medicaid Experiment

The health policy community has been abuzz with this question over the past few days, ever since a Harvard research team released a new round of results from a landmark study of Medicaid in Oregon. The study stands apart because it included a technique you may have learned about in Science 101: having a control group.

Researchers have always struggled with measuring how people with health insurance fare compared to a similar group without health insurance. In other words, how can you ethically offer health insurance to one group of people and not offer it to another in order to measure the results?

A policy decision in Oregon provided an opportunity to do this very thing. A few years ago, Oregon decided to expand Medicaid to low-income adults who hadn’t been eligible before, but the state didn’t have enough funding to cover all of them. So, Oregon set up a lottery in which 30,000 people were randomly selected from a Medicaid waiting list of 90,000. The lottery allowed researchers to study how enrollment in Medicaid affected recipients’ use of the health care system, their expenses and their health compared to those who were not selected.

What did the results show at the two-year mark of the Oregon research? Here are my top four takeaways:

1. Does Medicaid make you healthier?  The answer is a resounding “Maybe.” First, the good news. The researchers found that the new Medicaid enrollees were more likely to use preventive services and to report that their health was the same or better than a year ago, compared to their counterparts in the control group. However, the bad news created the most buzz: Medicaid coverage had no significant effect on blood pressure, hypertension, cholesterol or blood glucose (HbA1c, a marker for diabetes). There was also no change in obesity or the risk of heart disease in the future.
2. Depression as the bright spot? Of the handful of conditions measured, the one that showed improvement was depression. Medicaid enrollees experienced lower rates.
3. Use of some health services (and spending) increased. Rates of office visits and prescription drug use increased among Medicaid enrollees, but did not for hospital admissions or emergency department visits. On average, annual health care spending per recipient increased by about $1,200.
4. Greater financial security: Having coverage seemed to garner a greater sense of financial stability, as Medicaid enrollees reported lower levels of out-of-pocket spending, borrowing to pay for medical bills and medical debt.

This important study highlights areas where Medicaid holds promise (integration of primary and behavioral health care, increased use of preventive services)  and raises questions about its challenges (Are there enough clinicians to meet increased demand? How to best treat chronic diseases?) These results are obviously timely for Colorado, as Governor Hickenlooper prepares to sign a Medicaid expansion into law that could affect more than 200,000 Coloradans.