Oregon could provide case study on uninsured

A project is comparing state residents who received Medicaid coverage in 2008 through a random drawing with those who did not.

By Doug Trapp — Posted Aug. 27, 2010

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Many studies have tried to quantify the value of having health insurance, but architects of an ongoing project examining low-income Oregon adults say it could be the most extensive analysis so far. The work could yield lessons for states as they carry out the national health reform law's Medicaid expansion, which begins in 2014.

Researchers from northeastern Oregon universities and health systems are gathering information from state residents who applied for and were randomly selected to receive Medicaid coverage in 2008. The project, called the Oregon Health Study, is comparing people who were enrolled with those who were not.

"We're trying to understand the many different effects of gaining access to health insurance, in particular for low-income adults," said Katherine Baicker, PhD, a professor of health economics at the Harvard School of Public Health in Boston and the project's lead researcher. "To really isolate the effect of insurance itself ... you need a control group."

Oregon's Medicaid program received more than 85,000 applications for the coverage, made possible through a federal waiver, Baicker said. Of the 35,000 names drawn by the state, about a third both were determined to be eligible and signed up for coverage, she said. The program was open to adults with incomes under the federal poverty level, or $10,830 for an individual.

Baicker said the team is studying the impact of Medicaid coverage on health outcomes, access to care, service utilization and the type of care received. They also are examining the financial impact of being insured, and if it helped the enrollees get jobs. They will continue gathering data to the end of 2010 through in-person interviews, detailed questionnaires and utilization records. "This is going to be a really large-scale study," she said.

The team cannot yet draw conclusions about the impact of gaining coverage. But people who signed up for the Oregon waiting list and subsequently enrolled in Medicaid coverage were in worse health than others.

Also, some on the waiting list earned too much to qualify, which suggested substantial unmet demand for coverage among those with incomes just above the federal poverty level. The national reform law has targeted that population for expanded Medicaid coverage.

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