Abstract
ObjectivesTo examine the person‐level impact of Medicaid enrollment on costs, utilization, access, and health across previously uninsured racial/ethnic groups.Data SourceMedical Expenditure Panel Survey, 2008‐2014.Study DesignWe pooled multiple 2‐year waves of data to examine the direct impact of Medicaid enrollment among uninsured Americans. We compared changes in outcomes among nonpregnant, uninsured individuals who gained Medicaid (N = 963) to those who remained uninsured (N = 9784) using a difference‐in‐differences analysis.Principal FindingsMedicaid enrollment was associated with significant increases in total health care costs and total prescription drug costs and a significant decrease in out‐of‐pocket costs. Among those who gained Medicaid, prescription drug use increased significantly relative to those who remained uninsured. Medicaid enrollment was also associated with a significant increase in reporting a usual source of care, a decrease in foregone care, and significant improvements in severe psychological distress. Changes in total prescription drug costs and total prescription drug fills differed significantly across each racial/ethnic group.ConclusionsAmong a national sample of uninsured individuals, Medicaid enrollment was associated with substantial favorable changes in out‐of‐pocket costs, prescription drug use, and access to care. Our findings suggest Medicaid is an important tool to reduce insurance‐related disparities among Americans.
Highlights
The Oregon Health Insurance Experiment (OHIE), the most rigorous study to date to examine the impact of gaining Medicaid at the individual level, found that uninsured individuals who gained Medicaid in Oregon state had significantly lower levels of depression and out-of-pocket spending and higher levels of prescription medication use than individuals who were not enrolled in Medicaid.[16,17,18]
Among a national sample of previously uninsured Americans, enrollment in Medicaid was associated with significant increases in total medical spending and reductions in out-of-pocket costs, higher levels of prescription medication use, and improvements in access to care relative to individuals who remained uninsured
Twenty-eight million Americans remain uninsured in the United States,[41] and this number is expected to rise following the recent repeal of tax penalties related to the individual mandate and other federal changes to Medicaid eligibility.[42,43]
Summary
The Oregon Health Insurance Experiment (OHIE), the most rigorous study to date to examine the impact of gaining Medicaid at the individual level, found that uninsured individuals who gained Medicaid in Oregon state had significantly lower levels of depression and out-of-pocket spending and higher levels of prescription medication use than individuals who were not enrolled in Medicaid.[16,17,18] No other contemporary studies have followed individuals who gain Medicaid after a period of uninsurance Such studies would be helpful to build on the findings of the OHIE and may shed light on whether identified associations are consistent across time, region, and race/ethnicity. These data are critical because they can inform ongoing policy debates regarding the design and funding of Medicaid, as well as efforts to improve racial and ethnic disparities in care.[12,19,20,21,22]
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