One newly insured patient told us, “ no doctors that are actually taking new patients,” while another told us that Medicaid gave him new access to care, when previously he “would not go to see the doctor because of the cost.” These stories are both true – but it’s impossible to tell which is more typical without more systematic data. For nearly every outcome of interest, we heard stories of experiences that matched the average effect of the expansion on the newly covered population, as well as compelling stories that did not.įor example, we found that overall, Medicaid increased doctor’s office visits by about 50 percent – but not that every single person was able to see the doctor. We found that Medicaid increases health care use, improves financial security, improves self-reported health, and reduces rates of depression. The Oregon experiment has produced a wealth of data and rigorous evidence on the impact of Medicaid on people’s lives. Emergency rooms, from what I understand, they can never turn you away,” painting a vivid picture that, while true for this patient, does not happen to be representative of most people’s experiences. But an uninsured patient told us, “When I was uninsured, unless something happened where I had to go to the hospital, then I’d just go the emergency room and deal with it. just would have been too much for me to take on mentally or financially,” a story consistent with our overall finding. One newly insured patient told us, for example “Without coverage I wouldn’t have gone to ER those nights I was in crisis because I was already in crisis, and the idea of… the bills I would have had. But they also underscored how easy it is, in the absence of solid evidence, to find an anecdote to match any “answer.” These individual narratives were invaluable for deepening our understanding of the experiences of those in study. In addition to this evidence, gleaned from a randomized evaluation of the experiences of tens of thousands of uninsured and newly insured Oregonians, we also conducted hundreds of interviews to learn how people felt that having Medicaid-or not-affected their lives. New research tells us that this increase persisted for at least two years, and that Medicaid did not make patients more likely to substitute a visit to the doctor for one to the ED. We found that, contrary to many people’s expectations, Medicaid increased use of the ED by 40 percent. This let us gauge the effects of the program itself, isolated from the usual confounding factors, and allowed us to collect thousands of stories-otherwise known as data!-about people’s experiences on and off of Medicaid. In 2008, Oregon used a lottery to allocate a limited number of Medicaid slots – generating, in essence, a randomized controlled trial of Medicaid. Solid evidence is very hard to come by, but we had an opportunity to evaluate the impact of expanding Medicaid using scientifically rigorous methods rarely available in answering public policy questions. Medicaid Coverage and Care UseĪ key question in the Medicaid debate is whether expanded coverage reduces the use of the Emergency Department (ED) – getting people into the doctor’s office earlier, improving health, and reducing health care spending. Unfortunately, as moving as those stories can be, they can just as easily lead us in the wrong direction as the right one. Policies are not enacted in the abstract they affect real people’s lives, and we should all be concerned with how policy changes help or harm them. The stories that are told about the effectiveness-or lack thereof-of coverage in improving health and health care usually relate compelling personal experiences, putting a human face on an otherwise abstract argument. States, patients, and voters are wrestling with the pros and cons of dramatic changes in public health insurance coverage, including extending, maintaining, or rolling back Medicaid expansion under the Affordable Care Act (Obamacare) – an often emotional topic of debate.
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