The Oregon Health Insurance Experiment

Members of the public stand at tables at a polling center.

Findings of the Oregon Health Insurance Experiment

What’s the issue?

One of the principal strategies contained in the Affordable Care Act (ACA) to achieve near-universal health insurance coverage is expan­sion of eligibility for the Medicaid program. There has been much debate about whether expansion of the Medicaid program should be used to extend health care benefits to the low-income uninsured.

This brief summarizes findings of the Or­egon Health Insurance Experiment, a ran­domized controlled study made possible by a unique lottery process used in 2008 to expand Medicaid coverage in the state. The study ad­dresses many of the issues being considered by policy makers, including take-up rates and characteristics of enrollees; use of health ser­vices; health outcomes and measures of well-being; enrollee finances and medical debt; as well as indirect societal effects on labor mar­kets, private insurance coverage, and partici­pation in other public programs.

What’s next?

As ACA implementation continues, the find­ings of the Oregon Health Insurance Experi­ment can be useful to other states to help in estimating the impacts of Medicaid expan­sion on their budgets, designing programs to avoid some of the pitfalls experienced in Or­egon such as enrollment strategies and ben­efit design, working with providers to meet increased demands for services, and develop­ing broader strategies to improve the health status of enrollees.