Virginia Health Care Foundation

Does expanding health services to the uninsured make a significant impact?  A new study, The Oregon Health Insurance Experiment:  Evidence from the First Year, from the Robert Wood Johnson Foundation, shows positive results from expanding access to care.  In 2008, a group of uninsured low-income adults in Oregon was selected by lottery to be given the chance to apply for Medicaid. This lottery provides a unique opportunity to gauge the effects of expanding access to public health insurance on the health care use, financial strain, and health of low-income adults using a randomized controlled design. In the year after random assignment, the treatment group selected by the lottery was about 25 percentage points more likely to have insurance than the control group that was not selected.

The researchers found that in the first year of the lottery, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and better self-reported physical and mental health than the control group.

Other important recent studies and findings include:

• According to the Centers for Disease Control and Prevention, nearly half of American adults have hypertension, diabetes or high cholesterol, indicating a high percentage of the population has a condition associated with heart disease.
• The Robert Wood Johnson Foundation-sponsored 2010 State of the States details state-by-state trends in health care cost and coverage, Medicaid and CHIP, insurance reform and delivery system and payment reform.
• The NewsHour presented an in-depth review of the growing number of uninsured in the U.S. and followed-up with information on how the economic stimulus package is benefitting Community Health Centers nationwide.
• Rising Unemployment, Medicaid and the Uninsured:  New data, released January 2009, on how the current and projected future rise in unemployment in the U.S. is affecting health care and health insurance needs for children and adults.  Among the data included are that, for every increase of 1 percentage point in the national unemployment rate, it is estimated that an additional 1 million Americans turn to Medicaid for coverage and another 1.1 million go uninsured.
• Cover the Uninsured.org, an initiative of the Robert Wood Johnson Foundation has a wealth of data regarding uninsured Americans, including the fact that nearly 1 in 5 workers is uninsured.  For national level data, check out the Cover the Uninsured fact sheets.
• Health Insurance Coverage in America:  This 2008 Kaiser Family Foundation report documents the increase in the number and percent of Americans who are uninsured as well as the decline in employer-sponsored health insurance.
• Medicaid in a Crunch: A Mid-FY 2009 Update on State Medicaid Issues in a Recession: This report from the Kaiser Commission on Medicaid and the Uninsured, “relays the perspective of leading state Medicaid directors to describe the fiscal strain on Medicaid and other safety-net programs as enrollment swells and state tax revenues shrink, raising the prospect of program cutbacks. It draws on focused interviews with leading Medicaid directors in November 2008.”
• The Institute of Medicine Committee on the Consequences of Uninsurance revealed that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late, and to be sicker and die sooner.
• The Uninsured: A Primer:  This comprehensive document reviews “the basic profile of the uninsured population, how they receive care, the latest trends in health insurance coverage, and what the options are for increasing coverage.”  It was prepared by the Kaiser Commission on Medicaid and the Uninsured and updated in October 2007.
• Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2008 Current Population Survey. “This annual report examines the status of health insurance coverage in the United States, providing historic data through 2007 on the number and percentage of nonelderly Americans with and without coverage. It discusses the trends in coverage and highlights characteristics of the uninsured.” The Employee Benefit Research Institute released this report in September 2008.