Expanding Medicaid Lowers Depression, Financial Strain, But Doesn’t Improve Physical Health

While Medicaid coverage has helped to increase diabetes diagnoses and medication compliance among the poor, and reduce depression and out-of-pocket medical expenses, it has not helped to reduce the prevalence of diabetes, high cholesterol, or high blood pressure, according to a study by The Oregon Health Insurance Experiment, and which appears in the New England Journal of Medicine.

In 2008, Oregon held a lottery to give additional low-income, uninsured residents access to its Medicaid program; about 90,000 individuals signed up for the lottery for the 10,000 available openings. Approximately two years after the lottery, researchers from the the Harvard School of Public Health conducted more than 12,000 in-person interviews and health examinations of participants in the Portland, Oregon metropolitan area, and compared outcomes between those randomly selected in the lottery and those not selected in order to determine the impact of Medicaid coverage.

Key findings from the study include the following:

  • Medicaid had no significant effect on measures of hypertension or high cholesterol, or on the rates of diagnosis or use of medication for these conditions.
  • Those covered were 3.8 percent more likely to be diagnosed with diabetes, compared with 1.1 percent of those in the control group, and 5.4 percent more likely to use diabetes medication, compared to the 6.4 percent of the control group who used diabetes medication, but had no effect on glycated hemoglobin (a measure of diabetic blood sugar control).
  • Medicaid reduced rates of depression by 9 percentage points (compared to the 30 percent of the control group screening positive for depression) and increased self-reported mental health.
  • Medicaid virtually eliminated out-of-pocket catastrophic medical expenditures (defined as out-of-pocket medical expenditures in excess of 30 percent of household income) and reduced other measures of financial strain.
  • Medicaid increased healthcare use, including use of physician services, prescription drugs, and preventive care.

This is the first study evaluating the impact of Medicaid coverage on the uninsured, particularly timely given upcoming Medicaid expansion in 2014, researchers say. It is part of an ongoing research program examining many different effects of Medicaid, and represents a collaboration between non-profit and academic researchers and state policy makers. A previous study looking at data collected about a year after the lottery found that Medicaid substantially increased healthcare use, increased self-reported health, and reduced financial strain. More information can be found here.

Source: Harvard School of Pubic Health, April 2013:

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