Racial/Ethnic Differential Effects of Medicaid Expansion on Health Care Access (Health Services Research)

Authors assessed racial/ethnic differential impacts of the Patient Protection and Affordable Care Act's (AC) Medicaid expansion on low-income, nonelderly adults’ access to primary care using the Behavioral Risk Factor Surveillance System, State Physicians Workforce Data Book, and Bureau of Labor Statistics, in 2013 and 2015. Outcomes included health insurance coverage, having personal doctor(s), being unable to see doctors because of cost, and receiving a flu shot. Study authors tested racial/ethnic differential impacts using the “Seemingly unrelated estimation” method. Multiple imputations and survey weights were used. Low-income, nonelderly adults were identified based on age, household income, and family size.

Among the low-income, nonelderly adults, Medicaid expansion was associated with statistically significant gains in health insurance coverage, having personal doctors, and affordability. Hispanics had the fewest benefits, which significantly widened racial/ethnic disparities for the group. Racial/ethnic disparity in having personal doctors narrowed for non-Hispanic black and non-Hispanic others, although not the change was not statistically significant.

• Dahai Yue, MD, MS
• Petra Rasmussen, MPH
• Ninez A. Ponce, PhD, MPP