title: Gaining Coverage Through Medicaid Or Private Insurance Increased Prescription Use And Lowered Out-Of-Pocket Spending.
abstract: A growing body of literature describes how the Affordable Care Act (ACA) has expanded health insurance coverage. What is less well known is how these coverage gains have affected populations that are at risk for high health spending. To investigate this issue, we used prescription transaction data for a panel of 6.7 million prescription drug users to compare changes in coverage, prescription fills, plan spending, and out-of-pocket spending before and after the implementation of the ACA's coverage expansion. We found a 30 percent reduction in the proportion of this population that was uninsured in 2014 compared to 2013. Uninsured people who gained private coverage filled, on average, 28 percent more prescriptions and had 29 percent less out-of-pocket spending per prescription in 2014 compared to 2013. Those who gained Medicaid coverage had larger increases in fill rates (79 percent) and reductions in out-of-pocket spending per prescription (58 percent). People who gained coverage who had at least one of the chronic conditions detailed in our study saw larger decreases in out-of-pocket spending compared to those who did not have at least one condition. These results demonstrate that by reducing financial barriers to care, the ACA has increased treatment rates while reducing out-of-pocket spending, particularly for people with chronic conditions.
authors.affiliation: Andrew W. Mulcahy (amulcahy@rand.org) is a health policy researcher at the RAND Corporation in Arlington, Virginia.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Mulcahy
authors.affiliation: Christine Eibner is a senior economist at the RAND Corporation in Arlington.
authors.forename: Christine
authors.initials: C
authors.lastname: Eibner
authors.affiliation: Kenneth Finegold is a senior social science analyst at the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, in Washington, D.C.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Finegold
mesh_terms: D017046:Cost Savings; D016208:Databases, Factual; D016527:Drug Costs; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act / Q000191:economics* / Q000706:statistics & numerical data; D055656:Prescriptions / Q000191:economics / Q000706:statistics & numerical data*; D017149:Private Sector / Q000191:economics*; D012189:Retrospective Studies; D014481:United States
keywords: Access To Care; Chronic Care; Health Reform; Insurance Coverage < Insurance; Pharmaceuticals