First Advisor

Nancy Koroloff

Term of Graduation

Summer 2008

Date of Publication


Document Type


Degree Name

Doctor of Philosophy (Ph.D.) in Social Work and Social Research


Social Work and Social Research




Oregon Health Plan, Medically uninsured persons -- Oregon, Health insurance -- Oregon, Poor -- Medical care -- Oregon



Physical Description

1 online resource (2, xii, 148 pages)


In the United States, having health insurance is considered to be the best guarantee of having access to timely and effective health care services. With millions of uninsured adults in the U.S., many states have moved beyond traditional Medicaid programs and expanded eligibility to low-income adults who are not otherwise eligible for public health insurance. While popular with the public, these programs are vulnerable when states face economic downturns. Even during times of financial stability, Medicaid expansion programs experience significant amounts of program 'churning', and in turn, low-income adults experience health insurance discontinuity. For this reason, it is important to understand what happens when lowincome adults disenroll from public insurance.

This dissertation examines the experience of adults who disenrolled from a Medicaid-expansion program in Oregon following program changes instituted during a severe economic downturn for the state. Taking advantage of a timely prospective cohort study of Oregon Health Plan (OHP) participants, this secondary analysis of the data compares individuals who left the plan with individuals who were continuously enrolled. Patterns of insurance over the three-year period of the study and the amount of time spent uninsured for those that disenrolled from OHP were statistically modeled with outcomes that are important from a policy and social work practice perspective: access to health care, health care utilization, personal finances, and health decline.

There were five findings with particular relevance to social work practice and health policy: 1) Individuals who disenrolled from OHP had difficulties in finding other sources of insurance; 2) Irrespective of insurance status, individuals with chronic health conditions were vulnerable to poor outcomes; 3) In several analyses, returning to private insurance following a disenrollment from Medicaid was associated with better outcomes than returning to OHP or remaining uninsured; 4) Access to care improves when individuals have a usual source of health care, even controlling for the insurance experience; and 5) How you measure health insurance status matters- a more nuanced look at insurance status revealed different experiences that would have been masked by placing individuals into a category of insured or uninsured.


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