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Sue Ducat
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The Oregon Health Insurance Experiment


A new policy brief from Health Affairs and the Robert Wood Johnson Foundation summarizes the findings of the Oregon Health Insurance Experiment. In 2008 Oregon created a lottery system to award 10,000 new Medicaid slots to eligible new enrollees. From then until the implementation of the Affordable Care Act (ACA) in 2014, Oregon periodically used the lottery system to expand its Medicaid pool. The lottery offered a unique opportunity for research of Medicaid coverage, providing a randomized study population. A group of academic researchers subsequently organized the Oregon Health Study Group and created a study population from the reservation list, combining individuals who were selected with those who were not. The researchers found that those enrolled in Medicaid had a 35 percent higher chance of using outpatient care, a 30 percent higher rate of hospitalization, a 40 percent higher use of emergency departments, and a 15 percent higher likelihood of consuming prescription drugs.


Topics covered in this brief include:


      • What's the background? The brief traces the development of the Oregon Health Plan in the late 1980s, some twenty years after Medicaid began, to the present day. As the brief explains, coverage included a prioritized list of health services ranked according to their clinical and cost-effectiveness and value to society

      • What's the debate? As the brief explains, the Oregon Health Insurance Experiment has been cited by both advocates and opponents of the Medicaid program to support their position. Advocates point to the study findings related to reduced rates of depression and less financial strain, while critics stress that the program has strained state budgets and has not improved health outcomes.

      • What's next? As ACA implementation continues, the findings of the Oregon Health Insurance Experiment can help other states estimate the impacts of Medicaid expansion and design programs that avoid some of the pitfalls experienced by Oregon.
About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically and health policy briefs published twice monthly at Read daily perspectives on Health Affairs Blog. Download weekly Narrative Matters podcasts on iTunes.