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VOLUME 53 | NUMBER 3 | JUNE 2018

Did Health Care Reform Help Kentucky Address Disparities in Coverage and Access to Care among the Poor?

Objective: To evaluate the impact of Kentucky's full rollout of the Affordable Care Act on disparities in access to care due to poverty.

Data Source: Restricted version of the Behavioral Risk Factor Surveillance System (BRFSS) for Kentucky and years 2011–2015.

Study Design: We use a differenceindifferences framework to compare trends before and after implementation of the Affordable Care Act (ACA) in health insurance coverage, several access measures, and health care utilization for residents in higher versus lower poverty ZIP codes.

Principal Findings: Much of the reduction in Kentucky's uninsured rate appears driven by large uptakes in coverage from areas with higher concentrations of poverty. Residents in highpoverty communities experienced larger reductions, 8 percentage points (pp) in uninsured status and 7.5 pp in reporting unmet needs due to costs, than residents of lower poverty areas. These effects helped remove preACA disparities in uninsured rates across these areas.

Conclusion: Because we observe positive effects on coverage and reductions in financial barriers to care among those from poorer communities, our findings suggest that expanding Medicaid helps address the health care needs of the impoverished.

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