PORTLAND, Ore. — When Wendy Parris shattered her ankle, the emergency room put on an air cast and sent her on her way. Because she had no insurance, doctors did not operate to fix it. A mother of six, Parris hobbled around for four years, pained by the foot, becoming less mobile and gaining weight.
But in 2008, Oregon opened its Medicaid rolls to some working-age adults living in poverty, like Parris. Lacking the money to cover everyone, the state established a lottery, and Parris was one of the 89,824 residents who entered in the hope of winning insurance.
With that lottery, Oregon became a laboratory for studying the effects of extending health insurance to people who did not have it. Health economists say the state has become the single best place to study a question at the center of debate in Washington, D.C., as the Supreme Court prepares to rule, probably next week, on the constitutionality of President Obama’s health care law: What are the costs and benefits of coverage?
In a continuing study, an all-star group of researchers following Parris and tens of thousands of other Oregonians has found that gaining insurance makes people healthier, happier, and more financially stable. The insured also spend more on health care, dashing hopes of preventive-medicine advocates who have argued that coverage can save money — by keeping people out of emergency rooms, for instance.
For the nation, the lesson appears to be a mixed one. Expanded coverage brings large benefits to many people, but it is also more likely to increase a stretched federal government’s long-term budget responsibilities.
The newly insured of Oregon were more likely to describe their health as good and to say that their health was getting better, according to self-reported data that researchers are now combining with objective measurements. The uninsured reported being in worse physical and mental shape and were less likely to describe themselves as happy.
Getting insurance also had powerful financial effects, the study showed. The insured were 25 percent less likely to have an unpaid medical bill sent to a collection agency and 40 percent less likely to borrow money or skip paying other bills in order to cover their medical costs.
‘‘I feel like a different person,’’ said John Bell, a stay-at-home father who won the insurance lottery. ‘‘I was pretty grumpy all the time before.’’
Before winning the lottery, Bell filed for bankruptcy after emergency surgery to remove kidney stones left him with a $6,000 bill that he and his wife could not pay, he said. Today, Bell has a primary care physician who has encouraged him to lose weight and improve his diet to help control his diabetes.
The Oregon Health Study has won academic attention both because of the pedigree of the researchers — including Joseph P. Newhouse, who designed the renowned RAND Health Insurance Experiment in the 1970s, and Amy Finkelstein, the most recent winner of the John Bates Clark Medal, an economic prize considered second only to the Nobel — and the distinct nature of the state’s health insurance lottery. By assigning coverage randomly, Oregon gave researchers more confidence that they had teased out the true effects of insurance and had not been fooled by other differences between the insured and the uninsured.
“The study put to rest two incorrect arguments that persisted because of an absence of evidence,’’ said Katherine Baicker, a Harvard economist who worked on the study and served as an economic adviser to President George W. Bush.
“The first is that Medicaid doesn’t do anything for people, because it’s bad insurance or because the uninsured have other ways of getting care,’’ Baicker said. ‘‘The second is that Medicaid coverage saves money’’ by increasing preventive care, for instance.
“It’s up to society to determine whether it’s worth the cost,’’ she added.
Discussions with 17 insured and uninsured participants in the Oregon Health Study illuminated how coverage changed and did not change their lives. Many described poverty and its attending problems, not health care, as their major challenge. A handful said that they were not overly bothered by their lack of coverage or that winning Medicaid had not really had much of an effect.
But many, including Parris and Bell, said that Medicaid had made a significant — even transformative — difference in their lives.
Parris got surgery for her foot and additional care. She is also getting spinal surgery. Doctors have helped her address her depression, triggered by the death of one of her children. Her weight has come back down, and her mobility is far better. She said that she felt she was a better parent, and that her mood had improved, although she still had problems paying the bills.
“It saved my life,’’ she said.
Most of the uninsured described their lack of coverage as a profound problem.
For instance, a year ago, hair stylist Samantha Kious went to Planned Parenthood to seek birth control medication to manage her polycystic ovary syndrome, a common hormonal imbalance.
Kious, 24, who also suffers from depression and Crohn’s disease, an inflammatory bowel condition, makes only $1,000 to $1,200 a month and cannot afford insurance. The clinic performed some tests and prescribed Kious the pills. But they also told her that she had Stage 2 cervical cancer. As of now, the condition remains untreated. She and her boyfriend even considered getting pregnant so that she would automatically qualify for Medicaid.
‘‘It’s scary for me, having cancer and knowing I can’t do anything about it,’’ said Kious.