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 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.