The Oregon Health Insurance Experiment

A 2008 lottery extending Medicaid to selected residents allowed for a randomized study on the impact of Medicaid coverage.

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.