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Oregon provides fodder for health care debate

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Thursday, May 02, 2013

Second-year results of the ongoing "Oregon Health Insurance Experiment" were just published in The New England Journal of Medicine. This unique study was borne out of Oregon's decision to expand Medicaid to thousands of low-income adults selected by lottery in 2008. A team of researchers, led by MIT economist Amy Finkelstein, has tracked d this group and a control group who did not receive Medicaid and remained uninsured, observing the measurable health, financial and other effects of health insurance coverage.

So far the study – of 6,387  randomly selected adults with Medicaid and 5,842 randomly selected witout coverage – found "no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions," nor difference in "average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher."

It did find among those with coverage a higher diagnosis of diabetes and use of diabetes medication,less incidence ofr depression, increased  use of preventive care, and near elimination of "catastrophic out-of-pocket medical expenditures."

Given the political debate raging before a host of "Obamacare" reforms take effect next year, the study has gained a lot of attention. Forbes contributor David Whelan thinks the findings prove once again that having health insurance and being healthy are two different things.

Is having health insurance the same as having good health? The answer is no. People die every day despite great insurance. Others live long healthy lives without any coverage at all. The Amish community located 20 miles south of where I’m sitting includes many members of the second group. Yet the important distinction is usually lost by the time you travel 1,000 miles to Washington.

The Washington Post's WonkBlog calls the Oregon experiment a "beautiful, rare unicorn," due to therandomized clinical-trial data it provides, but the blog, written by Ezra Klein and Evan Soltas, concludes:

The problem with the Oregon study... is we don’t really know what we’re learning. It’s not clear, for instance, if the results are applicable to all health insurance, to all Medicaid insurance, or just to Oregon’s Medicaid program. It also only has two years worth of data, so we can’t know whether the sharp uptick in preventive medicine and diabetes diagnoses will pay off down the road.

Oregon is likely to remain in the health care glare as it moves ahead with CoverOregon, one of the first state health insurance exchanges to flesh out, initially limited to small businesses and individuals. Insurers are currently submitting their rate requests for next year, and individual rates could rise significantly as new mandates from the Affordable Care Act kick in.

For more on health care costs and reforms in Oregon, check out this month's Data Dig: What's driving the cost of health care?

Research editor This e-mail address is being protected from spambots. You need JavaScript enabled to view it digs heaps of data about privately-held and public companies, economics and industries.


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