New Medicaid Enrollees In Oregon Report Health Care Successes And Challenges
By Heidi Allen, Bill J. Wright and Katherine Baicker
Health Affairs, February 2014
In 2008 Oregon used a lottery to expand its Medicaid program for low-income adults, Oregon Health Plan Standard (OHP).
For this study we conducted 120 qualitative interviews among Oregon residents who had recently gained Medicaid coverage. Our purpose was to better understand how newly insured patients did—and did not—interact with the health care system
Group 1: Minimal Interactions With Health Care
Forty percent of the newly insured enrollees whom we interviewed did not use their coverage much, if at all. Low users gave one of the following four main reasons for not using their Medicaid benefits very often.
* Perception Of Good Health
* Confusion About Coverage
* Dissatisfaction With Care
* Access Barriers
Group 2: Regular Or Frequent Interactions With Health Care
The remaining 60 percent of respondents (called regular users) used their insurance more than a time or two but reported varying degrees of success.
* Regular Preventive Care And Minor Needs:
About one-tenth of the regular users took advantage of access to preventive care and also received treatment for occasional illnesses or injuries
* Immediate Health Improvement:
Another tenth of the regular users described an immediate transformation in their health after they received insurance. These people all had serious health problems that could be improved quickly, such as by getting back on a previously effective medication or having an operation that had been postponed because of lack of coverage. The members of this group saw their new insurance coverage as directly related to an improvement in their quality of life.
* Mixed Success:
Forty-four percent of regular users continued to experience challenges. Some interviewees were able to get partial treatment—such as prescriptions for chronic conditions—but had serious needs remaining. Some reported feeling misunderstood by physicians or being unable to build a relationship with a primary care provider. Others struggled with very poor health that continued to deteriorate even with regular treatment.
* Success Over Time:
Finally, 39 percent of regular users reported that their health had improved with insurance, but that it had taken time. They experienced incremental benefits once they found and built a relationship with the right doctor.
Often these users’ problems were addressed in order of severity or impairment. Lifestyle changes, such as modifications to diet and exercise, were not discussed until their acute symptoms had improved. Many of the positive changes that they reported were relatively recent.
http://content.healthaffairs.org/content/33/2/292.abstract
Comment:
By Don McCanne, M.D.
The “Oregon Health Insurance Experiment” made possible the comparison of uninsured patients with Medicaid patients by the natural experiment in which Medicaid patients were selected by lottery from a single population. The initial study reported was not powered to detect changes in health outcomes, but opponents of reform used the lack of demonstrable outcome differences to claim that Medicaid provides no health benefits for the patients enrolled. This new study of these Oregon Medicaid beneficiaries confirms that the claim of no health benefit was an outrageous extrapolation on the part of the opponents of ACA and Medicaid.
The majority of the 60 percent of the Medicaid beneficiaries who were regular users of care significantly benefited from the program. One-tenth experienced immediate health improvement, one-tenth benefited from preventive care and occasional acute care, 39 percent experienced incremental benefits over time, and 44 percent continued to experience challenges though many of them were able to receive partial treatment.
Some of the reasons given by the 40 percent of the Medicaid beneficiaries who did not use much health care are of concern. Some reasons relate to well-known problems with Medicaid being considered a second-rate welfare program, that is chronically underfunded, and that has access problems due to an insufficient participation by health care professionals.
We can conclude that Medicaid has some definite problems, but we also can refute the opponents of Medicaid and state that it is far better to be insured, even with Medicaid, than not to be insured at all. At the same time, we can also state that mixed results for a portion of the study group should be motive enough for us to advocate emphatically for a higher quality program for everyone – an improved Medicare for all.