To our health

An Oregon experiment bears out the need for national health care reform

A chorus of critics has long theorized that good health insurance does not equate to good health. Also, the corollary: A lack of coverage doesn't compromise health, since — according to this line of argument — the uninsured can get their basic needs met in emergency rooms.

Testing these hypotheses is tricky; it's unethical to deprive anyone of health insurance in order to create a control group. But, three years ago, Oregon spawned the perfect conditions to experiment. In 2008, some new spots opened up for qualified low-income adults to obtain Medicaid.

More than 85,000 Oregonians sought the coverage. The state had few choices except to draw names, creating winners and losers. Suddenly, researchers had an ethical way to test insurance "haves" against insurance "have-nots."

This month, the National Bureau of Economic Research published the initial findings of the Oregon Health Insurance Experiment. No single study is definitive, of course, and this one only examined one year. Still to come is crucial detail about the effect that insurance coverage had on blood pressure, cholesterol, blood sugar and obesity.

Nevertheless, the results thus far are impressive. Researchers drew on hospital discharge data, credit records (never before analyzed in a health insurance context, they believe) and death records, as well as responses to a survey — and the study establishes a clear link between health care and health.

"About one year after enrollment," researchers wrote, "... those selected by the lottery have substantial and statistically significantly higher health care utilization, lower out-of-pocket medical expenditures and medical debt and better self-reported health than the control group."

This won't, of course, resolve questions provoked by the 2010 Patient Protection and Affordable Care Act. But the study should help boost optimism about the new law. Certainly, the study bolsters the moral case for covering more Americans — because that coverage translates to improvements in their preventive care, perceived physical health, mental health and feeling of well-being.

The new health care reform law requires all states, by 2014, to extend Medicaid eligibility to adults at 133 percent of poverty level or below. The Oregon Health Plan, created under a waiver of federal Medicaid rules, consists of two programs. OHP Standard covers low-income adults, 19-64, who are U.S. citizens, have assets below $2,000 and have lacked health insurance for six months. OHP Plus covers pregnant women, children, the disabled and families receiving temporary assistance.

The program Oregon expanded in 2008 was OHP Standard; 10,000 Oregonians "won" the lottery. The rest lost, compounding the cruelty of another lottery — health itself.

Even though individuals can improve on their genes, they're still at the mercy of diseases, hazards and bad luck. Lack of coverage doubles down their bad fortune. The Oregon experiment provides the strongest evidence yet that universal health care could boost universal health, improving life and luck for us all.

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