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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 lowincome, 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: Quasiexperimental design with differenceindifferences 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: Lowincome, nonelderly adults were identified based on age, household income, and family size.

Principal Findings: Among the lowincome, 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 nonHispanic black and nonHispanic 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.

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