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J Ambul Care Manage. 2014 Oct-Dec;37(4):282-92. doi: 10.1097/JAC.0000000000000023.

Estimating demand for care after a medicaid expansion: lessons from Oregon.

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Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Drs Gold and Fortmann); Oregon Health & Science University, Department of Family Medicine, Portland (Drs Bailey, Marino, Heintzman, and DeVoe); Oregon Health & Science University, Department of Public Health & Preventive Medicine, Division of Biostatistics, Portland (Ms O'Malley); and OCHIN, Inc, Portland, Oregon (Messrs Hoopes and Cowburn and Dr Nelson).


To estimate how the Affordable Care Act's Medicaid expansions will affect demand for services, we measured ambulatory care utilization among adult patients who gained insurance during Oregon's 2008 Medicaid expansion. Using electronic health record data from 67 community health centers, we assessed pre- and postcoverage utilization among patients who gained insurance, compared with patients continuously insured or uninsured. In comparisons of the pre- and postcoverage periods, mean annual encounters among persons who gained insurance increased 22% to 35%, but declined in the comparison groups. These findings suggest that providers should expect a significant increase in demand among patients who gain Medicaid coverage through the Affordable Care Act.

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