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The article discusses how Medicaid coverage affects emergency department (ED) use based on the Oregon Health Insurance Experiment. Topics covered include the increased ED use as a result of the expansion of Medicaid coverage to more uninsured individuals, the expectation that primary care use will increase because of the expansion, and the impact of public health insurance on the relationship between visits to the physician's office and the ED.

Background: Despite the imminent expansion of Medicaid coverage for low-income adults, the effects of expanding coverage are unclear. The 2008 Medicaid expansion in Oregon based on lottery drawings from a waiting list provided an opportunity to evaluate these effects.Methods: Approximately 2 years after the lottery, we obtained data from 6387 adults who were randomly selected to be able to apply for Medicaid coverage and 5842 adults who were not selected. Measures included blood-pressure, cholesterol, and glycated hemoglobin levels; screening for depression; medication inventories; and self-reported diagnoses, health status, health care utilization, and out-of-pocket spending for such services. We used the random assignment in the lottery to calculate the effect of Medicaid coverage.Results: We 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. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression (-9.15 percentage points; 95% confidence interval, -16.70 to -1.60; P=0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures.Conclusions: This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined the effects of the expanding Medicaid coverage for low-income adults in the U.S. using the 2008 Medicaid expansion in Oregon. Results revealed no significant effect of the coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for the conditions. It concludes that the coverage generated no significant improvements in measured physical health outcomes in its first two years of implementation.