Expanding Medicaid - Good, Bad, or Ugly?

Possibly the most important health economics paper of the year, especially as it relates to the debates surrounding Obamacare. Here is the abstract:

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. We find that in this first year, 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.

Some quick thoughts:
-Possibly one of the first randomized studies to show a positive impact of insurance on self-reported well-being. While some may pooh-pooh at the fact that the effects were on self-reported health rather than objective measures, I would argue that such subjective measures are equally, if not more, important.

-The randomized design obviously gives you a solid estimate of the average treatment effect for this population. However, Oregon is a unique place and the people targeted were unique, as well (low-income people who were aching for insurance). It remains to be seen if this result would generalize elsewhere.

-These effects are for 1 year out. It would be interesting to see how this all fares in the medium and long-run. Would increased preventative and primary care utilization now lead to cost-savings down the road? One would hope.