- Bob Roehr, journalist
- 1Washington, DC, USA
Access to healthcare through Medicaid generated no significant improvements in measured physical health outcomes in the first two years of coverage for a low income population in Oregon, according to a much anticipated paper in the New England Journal of Medicine.1
However, enrollment in Medicaid increased the use of healthcare services, raised rates of diabetes detection and management, lowered rates of depression, and reduced financial strain among beneficiaries.
Medicaid is most often thought of as a safety net insurance program that provides access to essential medical services for people on low incomes. The mixed message from this study on its effects on health adds fuel to the ongoing debate over expansion of the federal/state Medicaid program under provisions of the Affordable Care Act.
A unique opportunity
The unique opportunity for the study arose in 2008 when Oregon had limited funding to expand access to Medicaid and a waiting list of almost 90 000 people. The state used a lottery to draw the names of about a third of the people on the waiting list, who then went on to formally apply for Medicaid and enroll if they met the entry criteria.
Researchers took advantage of the randomization of Medicaid beneficiaries in their study. Analysis was based on 12 229 people in the Portland area who responded to the survey (73% response rate). Half had gained access to Medicaid under the lottery expansion and half had not; the groups shared a similar sociodemographic profile. There were no copayment barriers to accessing services.
“We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or …