Medicaid Expansion is the new individual mandate. After two years of challenges to the law’s centerpiece, debate shifts to whether or not states will participate in expanding coverage to nearly 16 million people nationwide. So far, opponents assert that we can’t afford to, but careful analysis in Oregon would support the position that we can’t afford not to.
Quantified insights into Medicaid’s effect comes courtesy of a unique 2008 Oregon circumstance when about 85,000 people applied for 10,000 available openings. Once individuals were enrolled, researchers had a perfect scenario – a randomly selected pool of 10,000 test subjects and a control group for comparison.
Katherine Baicker and her peers found that participants experienced significantly improved security and well-being on multiple dimensions. Just getting enrolled triggered increases in self-reported health (25 percent) and happiness (30 percent), with a corresponding decrease in likelihood to screen positive for depression (25 percent). By the end of the first year, financial strain reduction was equally clear, with a 40 percent decline in skipped payments or need to borrow money and 25 percent fewer unpaid bills sent to collection (for all types of bills, not just medical ones). Enrollees sought and got primary and preventive care and stayed away from emergency rooms. There was an increase in hospitalizations compared to the control group, but they were planned stays that likely stave off not just future emergent visits but overall higher costs of care down the road.
Researchers have only been through the first year of data so far, but things seem to be playing out the way expansion proponents projected. Ten thousand Oregonians became happier, healthier, more secure and therefore much less of a challenge to the system and the state as a whole. The only study of its kind would seem to allow the conclusion that Medicaid expansion isn’t just a good thing to do on behalf of those who don’t have access to health care, but the right thing to do for everyone.