Reaction to the Oregon Medicaid Study | Health Policy Blog |

Reaction to the Oregon Medicaid Study | Health Policy Blog |

Comments by Robert Nelson, MD

The justification for Medicaid expansion rests on the premise that lack of access to insurance coverage (in this case Medicaid) has a negative impact on health and maybe even mortality. The circumstance surrounding the Oregon Medicaid “lottery” provided a chance to do study this very question, which had never been done before: What are the effects on a large population who go from uninsured to insured?

The Oregon study is the only randomized, controlled study ever conducted on the effects of having health insurance versus no health insurance. Randomized, controlled studies are the gold standard of such research. The results measured and reported from the Oregon study were exactly the results the study design was intended to measure: That is, the effects of going from uninsured to insured. Period. 

It was a good study because it had a cohort matched, real time control group of about 60,000 people and a “study” group of about 18,000 of the original 30,000 (some didn’t qualify and some did not return enrollment applications)- these are not small numbers. Of the total study population, the only difference in the control group was that they were not awarded a medicaid slot. 

The Oregon Health Insurance Experiment may be the most important study ever conducted on the effect of going from no insurance to having health insurance. Oregon officials randomly assigned thousands of low-income Medicaid applicants – basically, the most vulnerable portion of the group that would receive coverage under ObamaCare’s Medicaid expansion – either to receive Medicaid coverage, or nothing. Health economists then compared the people who got Medicaid to the people who didn’t.

Here are the study’s results and conclusions:

“This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.”

The results of this one of a kind landmark study did not support the main premise behind the justification for expanding Medicaid.


If fact, it calls into question a more fundamental issue, which is this. We’ve too long equated coverage with care. Does coverage equal care? Does easier access equate to better health? The answer, at least as it applies to Medicaid expansion is a unequivocal NO.

Those of us who have been taking care of patients for many years in a third party dominated system have been stressing this distinction for years. It is time to reform the medical safety net by moving from an ineffective, bureaucratically heavy system of defined benefits, to a patient-centered incentivized system of defined contributions combined with full coverage for true emergencies.

The policy makers and academics were not listening. Maybe now we have their attention for a while.