Dean Baicker on the Oregon Health Insurance Experiment

One of the projects that I spent the most
time on in recent years is the Oregon Health
Insurance Experiment. Where we had the
opportunity to evaluate the multifaceted effects of
Medicaid, using a randomized, controlled trial,
which is almost never available in public policy. But Oregon had a lottery
for a limited number of Medicaid slots, and they
drew names from a waiting list. The people whose names
were drawn got Medicaid, and the people whose
names weren’t drawn didn’t get Medicaid. So we were able to
use that to figure out what exactly this major
health insurance program does. And we found some things
that supported people who were in favor of expanding
Medicaid and some things that supported people who were not
in favor of expanding Medicaid, and it was really interesting
to see how that played out in the public policy sphere. We could eliminate the
really unduly optimistic view of Medicaid. Some people thought Medicaid
was such a wonderful program, that it would expand health
care and improve health for low-income populations,
get them out of the emergency department, back
in the workforce, and actually save money. It turns out Medicaid
doesn’t save money. When you expand
health insurance, people do use more health care. And that’s great
for their health, but it doesn’t save
the government money. We could also eliminate
the unduly pessimistic view of the program, that Medicaid
was a terrible program that didn’t get people access
to health care, that didn’t improve their health at all. In fact, people who got Medicaid
had much better access to care, had much reduced
financial strain. They didn’t have bills
sent to collections. They weren’t turned away
from providers because of bills they hadn’t paid. Their depression
dropped by about 30%. They used more preventive care. They’re self-reported
health was better. They didn’t have a
lot of improvement in things like blood
pressure or diabetes. So it was a little bit of a
mixed bag on the health side, but they were definitely
much better off than if they were uninsured. Well, that’s a tough
problem for policymakers, and that gets back to having
a good analytical toolkit. It would be easy to
decide about a program, like Medicaid, if it was
all upside, if people were better off, and it
didn’t cost any money. Or if it was all downside, if
people were not any better off, and it was expensive. But of course,
like most policies, it has some winners
and some losers. And having a really
rigorous way to think through what that means
policymakers should do, that’s the mission of
Schools of Public Policy.

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