Health Reform Medicaid

Wisconsin is not Oregon

Recently in the news, a psuedo-randomized trial of Oregon’s Medicaid expansion found that people with Medicaid used more healthcare services.  They use more doctor visits, more medications and even a few more ER visits and hospitalizations (though these last two were not statistically significant).  Some policymakers believed that insurance will decrease ER visits and hosptializations due to increased access to primary care.

Although this is not the case in Oregon, in Wisconsin (my home state) Tom Deleire and co-authors (2013) found:

In the twelve months following enrollment in public insurance, outpatient visits for the study population increased 29 percent, and emergency department visits increased 46 percent. Inpatient hospitalizations declined 59 percent, and preventable hospitalizations fell 48 percent.

How did Deliere’s team determine this was the case?  The used a natural experiment introduced by a Medicaid expansion in Wisconsin.

In 2009 Wisconsin introduced a new public health insurance program—the BadgerCare Plus Core Plan—for adults without dependent children who have incomes up to 200 percent of poverty and who do not have access to other forms of health insurance. In January 2009 the state automatically enrolled 12,941 childless adult residents from Milwaukee County. The rollout of the program included extensive outreach by the state and county to providers, advocacy groups, community-based organizations, and eligible people.

Because enrollment was automatic for this subset of individuals, the insurance choice was in effect an exogenous variable.

Although inpatient hospitalizations decreased, ER visits rose.  The authors conclude that access to primary care and outpatient mental health services may mitigate any increase in ED use and its associated inefficiencies.


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