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Research ArticleOriginal Research

Short-Term Impacts of Coverage Loss in a Medicaid Population: Early Results From a Prospective Cohort Study of the Oregon Health Plan

Matthew J. Carlson, Jennifer DeVoe and Bill J. Wright
The Annals of Family Medicine September 2006, 4 (5) 391-398; DOI: https://doi.org/10.1370/afm.573
Matthew J. Carlson
PhD
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Jennifer DeVoe
MD, Dphil
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Bill J. Wright
PhD
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Article Figures & Data

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  • Figure 1.
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    Figure 1.

    Unmet health care need by insurance status.

    Unmet Need: P = .001, χ2 test.

    Prescriptions: P = .001, χ2 test.

  • Figure 2.
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    Figure 2.

    Utilization of health care by insurance status.

    Primary care: P = .001, χ2 test.

    Emergency department visits: not significant.

  • Figure 3.
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    Figure 3.

    Financial outcomes by insurance status.

    Medical debt: P = .001, χ2 test.

    Refused care: P = .001, χ2 test.

Tables

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    Table 1.

    Comparison of Study Respondents with Eligible Sample

    Demographic CharacteristicsEligible OHP Sample n = 8,260 %Study Respondents n = 2,783 %
    OHP = Oregon Health Plan.
    * P <.05.
    Sex, female*60.667.3
    Race/ethnicity*
        Asian3.52.1
        African American10.08.1
        Hispanic14.111.4
        Native American/American Indian9.59.3
        White62.869.1
    Primary language*
        English87.992.1
        Spanish7.65.9
        Other4.51.7
    Eligibility category
        OHP Plus51.650.5
        OHP Standard48.449.5
    • View popup
    Table 2.

    Sample Characteristics by Insurance Status

    Demographic CharacteristicStable Coverage (n = 712) %Disrupted Coverage (n = 183) %Lost Coverage (n = 405) %
    GED = general equivalency diploma; FPL = federal poverty level.
    * χ2, P <.01.
    † χ2, P <.05.
    Mean age, y*423839
    Sex†
        Female675860
        Male334240
        Total100100100
    Race/ethnicity*
        White (non-Hispanic)677172
        Black (non-Hispanic)557
        American Indian/Alaskan Native (non-Hispanic)1294
        Other (non-Hispanic)536
        Hispanic111211
        Total100100100
    Primary language
        English929295
        Spanish885
        Total100100100
    Education
        > High school455446
        High school/GED352936
        < High school201718
        Total100100100
    Income as percentage of FPL*
        100+81820
        26–100455539
        1–25231420
        0181015
        Not reported636
        Total100100100
    Health status
        Very good, excellent212822
        Good343737
        Fair, poor453541
        Total100100100
    Any chronic illness†
        No475555
        Yes534545
        Total100100100
    • View popup
    Table 3.

    Adjusted Odds Ratios for Reporting Unmet Health Care Needs, Primary Care Utilization, and Medical Debt in the Past 6 Months

    Insurance StatusOdds of Unmet Health Care Needs n = 1,271Odds of Unmet Medication Needs n = 1,271Odds of Primary Care Use n = 1,272Odds of Medical Debt n = 1,239
    Note: Model adjusted for age, sex, race, language, income, education, health status, and chronic disease.
    * P <.01.
    † P <.05.
    Stable coverage1.001.001.001.00
    Disrupted coverage1.85* (1.28–2.67)1.16 (0.81–1.68)0.66†(0.44–0.99)1.99* (1.35–2.93)
    Lost coverage5.55* (4.17–7.38)2.05* (1.55–2.71)0.18* (0.13–0.24)3.06* (2.28–4.12)
    • View popup
    Table 4.

    Adjusted Odds Ratios for Reporting Unmet Health Care Needs, Primary Care Utilization and Medical Debt in the Past 6 Months—Full Model

    CharacteristicsOdds of Unmet Health Care Needs n = 1,271Odds of Unmet Medication Needs n = 1,271Odds of Primary Care Use n = 1,271Odds of Medical Debt n = 1,239
    GED = general equivalency diploma; FPL = federal poverty level.
    * P <.01.
    † P <.05.
    Insurance status
        Stable coverage1.001.001.001.00
        Disrupted coverage1.85*1.160.66†1.99*
        Lost coverage5.55*2.05*0.18*3.06*
    Age0.98†0.991.000.97*
    Sex
        Female1.001.001.001.00
        Male0.950.74†0.52*1.46†
    Race/ethnicity
        White (non-Hispanic)1.001.001.001.00
        Black (non-Hispanic)1.060.990.891.31
        American Indian/Alaskan Native (non-Hispanic)0.680.49†0.960.74
        Other (non-Hispanic)1.210.570.851.05
        Hispanic1.191.450.821.03
    Primary language
        English1.001.001.001.00
        Spanish0.32*0.16*0.600.41†
    Education
        More than high school1.001.001.001.00
        High school/GED0.61*1.040.67*0.74
        Less than high school0.74*1.350.62†1.42
    Income as % of FPL
        100%+1.001.001.001.00
        26%–100%1.150.860.820.64
        1%–25%1.130.710.790.54
        0%0.990.610.560.44
        Not reported0.981.010.631.31
    Health status
        Very good/excellent1.001.001.001.00
        Good1.41†1.92*1.011.91†
        Fair/poor3.04*3.76*1.93†4.38*
    Any chronic illness
        No1.001.001.001.00
        Yes1.182.24*1.39†1.33†

Additional Files

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  • The Article in Brief

    Short-term Impacts of Coverage Loss in a Medicaid Population: Early Results From a Prospective Cohort Study of the Oregon Health Plan

    Matthew J. Carlson, PhD, and colleagues

    Background The expansion of Medicaid programs over the past 20 years has improved access to health care for millions of low-income Americans. In recent years, however, states have reduced Medicaid spending to save costs. This study examines the immediate effects of disrupted or lost medical coverage on adults enrolled in Medicaid. In particular, the study looks at the effect of changes in Medicaid in the Oregon Health Plan (OHP) implemented in February, 2003.

    What This Study Found Nearly one half (45%) of those enrolled in the OHP Standard plan experienced disrupted or lost medical coverage in the first 10 months after the plan was redesigned. In contrast, during the same period 1 year earlier, enrollment declined by only 3%. Those who lost coverage reported significantly worse access to health care and medication and higher medical debt than those with stable coverage. In addition, those whose insurance coverage was disrupted were less likely to get needed medical care and less likely to be able to afford needed prescription medicine than those with stable coverage.

    Implications

    • Changes in the Oregon Health Plan resulted in immediate loss of medical coverage, unmet health care needs, and increased debt for many low-income adults.
    • Even short gaps in medical coverage can result in less access to health care and more financial burden.
    • Those whose access to health care and medications is reduced in the short-term may have worse health with time, and may be more likely to need emergency department or hospital services.
    • Because most states in the US have made changes to their Medicaid programs similar to those in Oregon, this research has national implications.
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The Annals of Family Medicine: 4 (5)
The Annals of Family Medicine: 4 (5)
Vol. 4, Issue 5
1 Sep 2006
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Short-Term Impacts of Coverage Loss in a Medicaid Population: Early Results From a Prospective Cohort Study of the Oregon Health Plan
Matthew J. Carlson, Jennifer DeVoe, Bill J. Wright
The Annals of Family Medicine Sep 2006, 4 (5) 391-398; DOI: 10.1370/afm.573

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Short-Term Impacts of Coverage Loss in a Medicaid Population: Early Results From a Prospective Cohort Study of the Oregon Health Plan
Matthew J. Carlson, Jennifer DeVoe, Bill J. Wright
The Annals of Family Medicine Sep 2006, 4 (5) 391-398; DOI: 10.1370/afm.573
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