Racial/Ethnic Differential Effects of Medicaid Expansion on Health Care Access

Objective To assess racial/ethnic differential impacts of the ACA's Medicaid expansion on low‐income, nonelderly adults’ access to primary care. Data Sources Behavioral Risk Factor Surveillance System, State Physicians Workforce Data Book, and Bureau of Labor Statistics, in 2013 and 2015. Study...

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Bibliographic Details
Published in:Health services research 2018-10, Vol.53 (5), p.3640-3656
Main Authors: Yue, Dahai, Rasmussen, Petra W., Ponce, Ninez A.
Format: Article
Language:English
Subjects:
Analysis
health care access
Health insurance
Health insurance industry
Households
Medicaid
Medicaid Coverage Expansion
Medicaid expansion
Physicians
racial/ethnic disparities
Surveys
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Summary:Objective To assess racial/ethnic differential impacts of the ACA's Medicaid expansion on low‐income, nonelderly adults’ access to primary care. Data Sources Behavioral Risk Factor Surveillance System, State Physicians Workforce Data Book, and Bureau of Labor Statistics, in 2013 and 2015. Study Design Quasi‐experimental design with difference‐in‐differences analyses. Outcomes included health insurance coverage, having personal doctor(s), being unable to see doctors because of cost, and receiving a flu shot. We tested racial/ethnic differential impacts using the “Seemingly unrelated estimation” method. Multiple imputations and survey weights were used. Data Collection/Extraction Methods Low‐income, nonelderly adults were identified based on age, household income, and family size. Principal Findings Among the low‐income, nonelderly adults, Medicaid expansion was associated with statistically significant gains in health insurance coverage, having personal doctors, and affordability. Hispanics got the fewest benefits, which significantly widened racial/ethnic disparities for the Hispanic group. Racial/ethnic disparity in having personal doctors narrowed for non‐Hispanic black and non‐Hispanic others, although not statistically significant. Conclusion Medicaid expansion improved access to primary care, but it had differential effects among racial/ethnic groups resulting in mixed effects on disparities. Further research is necessary to develop tailored policy tools for racial/ethnic groups.
ISSN:0017-9124
1475-6773
DOI:10.1111/1475-6773.12834