Low-Cost Behavioral Nudges Increase Medicaid Take-Up Among Eligible Residents Of Oregon

Health Aff (Millwood). 2017 May 1;36(5):838-845. doi: 10.1377/hlthaff.2016.1325.


Efforts to reduce the ranks of the uninsured hinge on take-up of available programs and subsidies, but take-up of even free insurance is often less than complete. The evidence of the effectiveness of policies aiming to increase take-up is limited. We used a randomized controlled design to evaluate the impact of improved communication and behaviorally informed "nudges" designed to increase Medicaid take-up among eligible populations. Fielding randomized interventions in two different study populations in Oregon, we found that even very low-cost interventions substantially increased enrollment. Effects were larger in a population whose members had already expressed interest in obtaining coverage, but the effects were more persistent in low-income populations whose members were already enrolled in other state assistance programs but had not expressed interest in health insurance. The effects were similar across different demographic groups. Our results suggest that improving the design of enrollment processes and using low-cost mass-outreach efforts have the potential to substantially increase insurance coverage of vulnerable populations.

Keywords: Behavioral Economics; Insurance Coverage < Insurance; Medicaid; Take-Up.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Costs and Cost Analysis / economics*
  • Female
  • Health Services Accessibility
  • Humans
  • Insurance Coverage / statistics & numerical data*
  • Insurance, Health / statistics & numerical data*
  • Male
  • Medicaid / economics*
  • Medicaid / statistics & numerical data*
  • Medically Uninsured / statistics & numerical data
  • Oregon
  • Poverty
  • Socioeconomic Factors
  • United States