Oregon Medicaid health experiment
The Oregon health insurance experiment (sometimes abbreviated OHIE)[1] was a research study looking at the effects of the 2008 Medicaid expansion in the U.S. state of Oregon, which occurred based on lottery drawings from a waiting list and thus offered an opportunity to conduct a randomized experiment by comparing a control group of lottery losers to a treatment group of winners, who were eligible to apply for enrollment in the Medicaid expansion program after previously being uninsured.
"[4][5] Commentators in publications such as Forbes and RealClearPolitics cited the study as evidence that the Medicaid program fails its central cause of assisting the American poor,[4][5] but other commentators in publications such as The New Republic and the Daily Kos stated that the evidence of improved financial security and mental health provided a significant social benefit.
Because of the randomized controlled design, the study was able to isolate the effects of insurance from confounding factors such as the initial health status of participants.
[5][6] The researchers compared lottery winners who had the chance to enroll in Medicaid to individuals not selected in the lottery, using a standard two-stage least-squares instrumental-variable regression from their data to assess the effect of Medicaid coverage on many outcomes, including health care use, financial strain, and mental and physical health.
[8] The researchers could not reject the decrease in blood sugar that would be expected to result from the increased use of diabetes medication, based on the clinical literature.
The population examined was from only one state, and data collection involving in-person interviews and physical exams was limited to the Portland metropolitan area.
Avik Roy wrote for Forbes that the reported "result calls into question the $450 billion a year we spend on Medicaid, and the fact that Obamacare throws 11 million more Americans into this broken program."
"[5] Megan McArdle stated in The Daily Beast that "it's hard for me to look at this study and see the kinds of numbers that save tens of thousands of lives every year" even though proponents of expanded Medicaid as a part of health care reform had claimed so.
The editorial board of The Wall Street Journal argued that "Federal Medicaid rules require states to offer all-you-can-eat benefits to everyone rather than targeting public assistance to those most in need.
"[7] National Review Online ran a commentary by Jeremy Rozansky, who argued that "Medicaid is clearly a poor use of hundreds of billions of dollars."
"[7] John McDonough of the Harvard School of Public Health, writing for The Boston Globe remarked, "These results have changed no one's mind about Medicaid... because, in the end, this is not a debate about numbers or data or studies."
Taking greater steps to identify health problems before they happen has also been touted as a key requirement in keeping healthcare costs low over the long term.
And improvements in financial security—including a 40 percent drop in the likelihood of having to take out a loan or leave other bills unpaid due to spending on healthcare—are a promising sign if the aim is to make healthcare more affordable.
This reflects that Medicaid is, in large part, a redistributive income-support program, which is desirable given persistently high unemployment and widening wage gaps.
"[17] Ezra Klein wrote for Bloomberg that the "bottom line is that Medicaid worked" and called into question some of the technical particulars of the study.
[20] Richard Kronick of the United States Department of Health and Human Services and Andrew B. Bindman of the University of California, San Francisco wrote in The New England Journal of Medicine, "Insurance has three main purposes: to protect financial assets in the event of illness, to improve access to care, and to protect health... these results confirm the capacity of Medicaid to quickly and positively accomplish at least two of the three goals of insurance.
