NCPA - National Center for Policy Analysis

Study Finds Expanding Medicaid Didn't Lead To Big Health Gains

May 2, 2013

Although expanding Medicaid coverage to some low-income Oregon residents substantially improved their mental health and reduced financial strains on them, it didn't significantly boost their physical health, according to a study published in the New England Journal of Medicine.

The findings are less upbeat than a preliminary report by the same group, which had found that Medicaid made a "big difference" in people's lives. In the latest effort, researchers dug deeper. They compared health status, finances and use of health services between two groups of residents: some of the 10,000 people who had been selected through a lottery drawing for health insurance coverage under a 2008 limited expansion to Oregon's Medicaid program and those who had applied but did not get accepted.

  • Based on analyses of 12,229 people -- 6,387 of whom gained coverage -- the study's results did not show any significant difference in the levels of high blood pressure, high cholesterol and diabetes between the two groups two years after the lottery.
  • The study did find improvements in other categories, including mental health.
  • Gaining access to Medicaid, for example, reduced depression by 30 percent and also increased participants' use of physician services, prescription drugs and preventive care.
  • It also led to increased detection of diabetes and use of medication to control it.
  • Those covered by Medicaid also had lower out-of-pocket spending, the researchers reported, including a 4.5 percentage point difference in catastrophic expenditures.

Dr. Devon Herrick, a senior fellow at the National Center for Policy Analysis, says he was shocked to see so little data suggesting that Medicaid expansion improved overall health.

"It didn't seem to affect the outcome of those with diabetes," says Herrick. "It boosted their use of medication but didn't seem to improve their health -- that's something we would all assume."

Herrick says, "The results of this indicate that states can't just expand Medicaid and as a result, suddenly improve the health of all those that enroll -- it didn't seem to work that way."

Sources: Alvin Tran, "Expanding Medicaid Didn't Lead To Big Health Gains In Oregon, Study Finds," Kaiser Health News, May 1, 2013. Katherine Baicker et al., "The Oregon Experiment -- Effects of Medicaid on Clinical Outcomes," New England Journal of Medicine, May 2, 2013.


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