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