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APHA Scientific Session and Event Listing

Heidi L. Allen, MSW¹, Briar Ertz-Berger, MD², Robert A. Lowe, MD, MPH², and Katherine J. Riley, EdD³. (1) Graduate School of Social Work, Portland State University, PO Box 751, Portland, OR 97207, 503-725-4712, heidi.allen@state.or.us, (2) Center for Policy & Research in Emergency Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd., Mailcode CR 114, Portland, OR 97239-3098, (3) Public Health & Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., CB669, Portland, OR 97239-3098

In 2003, budget deficits led to restructuring of the Oregon Health Plan (OHP), Oregon's Medicaid expansion program. OHP instituted co-pays, increased premiums, eliminated benefits for dentistry, mental health and chemical dependency treatment, and created a lock-out period for enrollees who defaulted on their premiums. By the end of 2003, the expansion population had been reduced by 46%. This session will describe a qualitative study that explored how OHP policy changes impacted health care access for vulnerable individuals seeking care in an emergency department (ED). Several themes emerged: (1) participants sought ED care for acute exacerbations of chronic conditions; (2) becoming uninsured or under-insured impaired their ability to effectively utilize primary care resources in treating their illnesses, medication costs being a significant barrier; (3) patients reported instability with employment, parenting, housing, and general finance issues; and (4) respondents reported making difficult choices between paying for medical care and these other needs. We conclude that for these persons, the policy changes in OHP disrupted treatment for their chronic medical conditions – making them particularly vulnerable to acute illnesses. Having difficulty accessing health resources exacerbated precarious social circumstances and individuals perceived themselves as abandoned by the system.

Learning Objectives:

• Describe how Medicaid policy changes impact utilization of emergency room services according to the type of problems seen and possible preventable triggers.
• Discuss the role of unstable insurance and employment, poverty, and chronic medical conditions on the emergency care needed by former Medicaid recipients.
• Describe the impact of the Medicaid cuts in relation to family members and other significant persons.
• Describe how former Medicaid recipients perceive their situation in relation to other societal groups.

Keywords: Access to Health Care, Chronic Illness

Presenting author's disclosure statement:

Not Answered