The Oregon Health Insurance Experiment

May 3, 2013 1:49 PM

The Oregon Health Insurance Experiment, an outgrowth of Oregon's 2008 lottery to allocate Medicaid slots to eligible residents, has released their second year of results (Previous discussions on the lottery and the experiment). The gist of the results are that they found statisitically significant reductions in catastrophic health care expenditures, improvements in the incidences of depression, and increased use of health care services. They found minimal (and not statistically significant) improvements in the rates of physical health indicators (diabetes and hypertension) they tracked. Because of ethical concerns, there are no other randomized controlled tests on this scale that study the effects of Medicaid and few on the effects of health insurance in general (the only significant one being a RAND study released 30 years ago). Because of the small amount of information available on the topic and the impending Medicaid expansion offered by Affordable Care Act, this study has drawn a lot of attention from political commentators. This will presumably be the last year these results will be published, as the state of Oregon was able to find extra money in 2010 in order cover the rest of its Medicaid-eligible population.

Opinions from around the web: Josh Barro for Bloomberg (and a follow-up), Aaron Carroll and Austin Frakt for the Incidental Economist, Jonathan Chait for New York Magazine, Jonathan Cohn for the New Republic, Tyler Cowen for Marginal Revolution, Kevin Drum for Mother Jones, Ezra Klein for the Washington Post, Philip Klein for the Washington Examiner, Paul Krugman for the New York Times, Annie Lowry for the New York Times, Megan McArdle for the Daily Beast, Avik Roy for Forbes, Peter Suderman for Reason, David Whelan for Forbes, and Matthew Yglesias for Slate (and a follow-up).

posted by Weebot (20 comments total)

I like coupling part of these results (specifically, that people who have health insurance utilize health care services) with the results out of Washington State in regards to their Every Category of Provider law (all licensed health care professions are covered under insurance, no need for fancy riders) - which found that, in general, people who use CAM treatments (chiro, naturopathic, acu, massage) save buckets of money.

When those findings are teased apart, it turns out that, while generally healthy people using CAM cost insurance companies more money overall (more services, no serious problems anyway), people who were not in the best of health and used CAM more that made up for that cost.

Taken one step further.. As it says in the Oregon study, the people who utilize medicaid are typically not in the best of health, so giving them access to low cost, preventative care would be beneficial - if not medically (that wasn't studied), then certainly financially.
posted by hopeless romantique at 2:01 PM on May 3, 2013 [1 favorite]

I'm glad they got some data out of it...I found it pretty offensive that the solution to "we don't have enough money to cover everybody" was "let's have a lottery! Then lucky people won't have to die from lack of insurance." (And I say this as an Oregon resident who has high-deductible, catastrophic insurance -- if I ever had to come up with my deductible, it'd be a catastrophe!)
posted by spacewrench at 2:04 PM on May 3, 2013

This is a great post, and I really can't see how the results of this study are anything but supporting evidence that expanding Medicaid will help improve peoples lives.
posted by MisantropicPainforest at 2:10 PM on May 3, 2013

hopeless romantique, that Lind, Lafferty, Tyree, Diehr paper only shows results for "patients with back pain, fibromyalgia syndrome, or menopause symptoms". It's the definition of overgeneralizing to say that people who use CAM treatments save money. (I note that the papers' authors make the same error.) What it showed is that patients with those conditions have lower expenditures. Note, it also doesn't say anything about the efficacy of those treatments--only the cost.
posted by daveliepmann at 2:16 PM on May 3, 2013 [2 favorites]

You could open placebo clinics and that would save money too.
posted by kiltedtaco at 3:14 PM on May 3, 2013 [1 favorite]

if the discussion of paying for health care in the US had anything to do with "facts" we would have had some form of universal insurance (on one of any number of models) in the Nixon administration.

all of those little opinion essays from wonks or whoever are just blather by the smaller and smaller elite for whom getting sick enough to need a doctor or hospital isn't a potential financial catastrophe.

(you can tell this from all of the words wasted on whether diabetes and hypertension improved significantly after *2* years of health, when any idiot knows that these are both lifetime diseases for which by the time you are diagnosed it's already too late, and for which the best outcomes will come from preventative care.)
posted by ennui.bz at 3:21 PM on May 3, 2013 [1 favorite]

I found it pretty offensive that the solution to "we don't have enough money to cover everybody" was "let's have a lottery! Then lucky people won't have to die from lack of insurance."

What was a better solution? Put everyone on half-Medicaid that would end up doing no good at all and violates the terms of Medicaid funding to boot?

(Note: "Live in a perfect world where we have universal health care" was not an available option in Oregon at the time.)
posted by Etrigan at 4:32 PM on May 3, 2013

What was a better solution? Put everyone on half-Medicaid that would end up doing no good at all and violates the terms of Medicaid funding to boot?

Raising taxes to meet eligibility obligations would have also have worked.
posted by Weebot at 5:07 PM on May 3, 2013 [3 favorites]

Raising taxes to meet eligibility obligations would have also have worked.

Does this country look like kommunist Sverige to you? Here we fuck the poor because they obviously did something wrong otherwise why would bad things happen to them?
posted by Talez at 5:17 PM on May 3, 2013 [2 favorites]

"Worked" in the sense that it would have had to get through the state legislature, go into effect, get collected, not get rescinded by the next legislature...

Basically, if Oregon were the kind of place that was willing to find Medicaid for everyone, it would have funded Medicaid for everyone. No one was actually saying, "Hold on -- let's not give people medical care for the sake of a randomized controlled trial."

Realistically speaking, for the year of 2008, Oregon did what it could with what it had.
posted by Etrigan at 5:20 PM on May 3, 2013 [1 favorite]

Indeed, 2008 was not a particularly good year for net exporters of home construction materials.
posted by pwnguin at 6:00 PM on May 3, 2013

I think we should cut a deal: we'll continue to maintain a gigantic military so the EU doesn't have to, and in return they provide us with health care.
posted by George_Spiggott at 6:23 PM on May 3, 2013 [4 favorites]

The interesting thing is that conservatives are apparently using this to argue that Medicaid is unneeded because some health measurements like cholesterol and body fat(?) was the same between the people who had it and the people who didn't. But from what I understand, financially people were way better off and people who got medicade were able to get preventative care that they would have missed otherwise. That kind of thing will take a long time to pay off, but it should eventually.

Additionally, there was like a 30% decrease in depression.

I'm glad they got some data out of it...I found it pretty offensive that the solution to "we don't have enough money to cover everybody" was "let's have a lottery! Then lucky people won't have to die from lack of insurance."

I think it was that they found extra money to cover 10,000 people wouldn't normally qualify. Here's what Ezra Klein said: " A few years back, Oregon found the money to add 10,000 residents to the state’s Medicaid program. The only problem was that there were 90,000 residents who qualified for the program and desperately wanted in. So the state held a lottery."

So... it's a little ambiguous. Does he mean 90k people would normally qualify for Medicaid, or 90k people who qualified for some new threshold?

"Worked" in the sense that it would have had to get through the state legislature, go into effect, get collected, not get rescinded by the next legislature...

Medicaid is managed by state governments, for some reason or other, but paid for with federal tax money. States can certainly raise taxes and use the money to pay improve care.
posted by delmoi at 6:45 PM on May 3, 2013

So... it's a little ambiguous. Does he mean 90k people would normally qualify for Medicaid, or 90k people who qualified for some new threshold?

The plan was closed to new enrollment in 2004. In 2008, they found some money to add more people, but not nearly enough for everyone who qualified. Hence the lottery.
posted by Garm at 7:09 PM on May 3, 2013

I think it's quite telling that, in the USA, the only place we have universal, single payer healthcare is in the military. "Sure we'll pay to patch you up as long as you go back to killing brown people for us." Absolutely pathetic.
posted by InsertNiftyNameHere at 11:36 PM on May 3, 2013

I think it's quite telling that, in the USA, the only place we have universal, single payer healthcare is in the military. "Sure we'll pay to patch you up as long as you go back to killing brown people for us." Absolutely pathetic.

Well, that and the post-military VA that treats people who will never kill brown people for us again. Not to derail your everyone's-a-racist(-but-me) screed.
posted by Etrigan at 4:50 AM on May 4, 2013

Etrigan: "Well, that and the post-military VA that treats people who will never kill brown people for us again. Not to derail your everyone's-a-racist(-but-me) screed."

You've never known anyone who was seriously injured or disabled who has had to deal with the VA, have you?

Oh, I'm sorry Mr. Cheney, I'm sure you have. And I presume the VA is your primary source of health care? I've visited WWII, Korean War, and Vietnam War vets in those hospitals, and I treat my dogs better than most of those guys get treated. Bed bugs? Check. Bed Sores? Check. etc. etc. Over paid administrators who do nothing? Check. It works well in theory, but not so well in practice. And I'm pretty sure that is by design. But you keep telling yourself whatever you need to do.
posted by InsertNiftyNameHere at 6:13 AM on May 4, 2013

Etrigan: "Well, that and the post-military VA that treats people who will never kill brown people for us again. Not to derail your everyone's-a-racist(-but-me) screed."

You've never known anyone who was seriously injured or disabled who has had to deal with the VA, have you?

Oh, I'm sorry Mr. Cheney, I'm sure you have. And I presume the VA is your primary source of health care? I've visited WWII, Korean War, and Vietnam War vets in those hospitals, and I treat my dogs better than most of those guys get treated.

Go check my profile before you proclaim your moral high ground from having visited vets in the hospital a few times there, bubba.

Back now? Still feel like having this discussion based on your vast personal experience?
posted by Etrigan at 7:27 AM on May 4, 2013

Over paid administrators who do nothing? Check.
posted by InsertNiftyNameHere at 8:13 AM on May 4

I don't know, I work for a hospital that is basically across the street from a VA hospital, and I deal with their administrators fairly frequently (we share some staff, and the fellows in the fellowship program I administer do rounds over there). They are some of the hardest-working people I've met. Overworked, stressed, and understaffed, yes, but it's not that they're doing nothing.
posted by joannemerriam at 6:59 PM on May 4, 2013

Economist Austin Frakt (cited in Krugman's post) gives an interview on EconTalk, where his main message is that the statistical power of the study was simply too small compared to reasonable expectations for outcomes.
posted by pwnguin at 8:36 PM on May 13, 2013