Medicaid enrollment among previously uninsured Americans and associated outcomes by race/ethnicity-United States, 2008-2014

Abstract

Objectives: To examine the person-level impact of Medicaid enrollment on costs, utilization, access, and health across previously uninsured racial/ethnic groups.

Data source: Medical Expenditure Panel Survey, 2008-2014.

Study design: We 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 findings: Medicaid 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.

Conclusions: Among 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.

Keywords: access to care; disparities; health care costs; medicaid; uninsured.