Community Health Center Utilization Following the 2008 Medicaid Expansion in Oregon: Implications for the Affordable Care Act

Am J Public Health. 2016 Apr;106(4):645-50. doi: 10.2105/AJPH.2016.303060. Epub 2016 Feb 18.


Objectives: To assess longitudinal patterns of community health center (CHC) utilization and the effect of insurance discontinuity after Oregon's 2008 Medicaid expansion (the Oregon Experiment).

Methods: We conducted a retrospective cohort study with electronic health records and Medicaid data. We divided individuals who gained Medicaid in the Oregon Experiment into those who maintained (n = 788) or lost (n = 944) insurance coverage. We compared these groups with continuously insured (n = 921) and continuously uninsured (n = 5416) reference groups for community health center utilization rates over a 36-month period.

Results: Both newly insured groups increased utilization in the first 6 months. After 6 months, use among those who maintained coverage stabilized at a level consistent with the continuously insured, whereas it returned to baseline for those who lost coverage.

Conclusions: Individuals who maintained coverage through Oregon's Medicaid expansion increased long-term utilization of CHCs, whereas those with unstable coverage did not.

Policy implications: This study predicts long-term increase in CHC utilization following Affordable Care Act Medicaid expansion and emphasizes the need for policies that support insurance retention.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Community Health Centers / statistics & numerical data*
  • Community Health Centers / trends
  • Electronic Health Records
  • Health Services Accessibility
  • Humans
  • Insurance Coverage / trends
  • Insurance, Health / economics
  • Male
  • Medicaid / legislation & jurisprudence*
  • Medically Uninsured
  • Middle Aged
  • Oregon
  • Patient Protection and Affordable Care Act*
  • Retrospective Studies
  • United States