Disparities in the Impact of Medicaid Expansion on Adults in Poverty

Abstract

Introduction The Affordable Care Act’s Medicaid expansion in 2014 improved access to care. However, not all states adopted the expansion, and debates on reform or repeal continue. In addition, few studies have analyzed differential effects by demographic characteristics. Methods Using nationally representative data from the 2011-2016 Behavioral Risk Factor Surveillance System, we applied a difference-in-differences approach to compare changes in health care access, preventive care utilization, health status, and chronic illness diagnoses from pre- to post-expansion years stratified by race, age, income, and urban or rural residence. Results Medicaid expansion was associated with reductions in the uninsured rate (-5.4 percentage points, p<0.001), inability to afford doctor visits (-3.2 percentage points, p<0.001), and lack of a personal doctor (-4.6 percentage points, p<0.001). Whites and adults ages 55-64 in expansion states experienced significant improvements in health care access and routine checkup utilization not necessarily seen among other race or age groups. Medicaid expansion was associated with significant reductions in the uninsured rate among urban and rural residents, but only urban residents showed a significant increase in access to a personal doctor. Conclusions This study highlights important differences in Medicaid expansion’s effects on population subgroups. Medicaid expansion’s benefits to population health are important considerations for state expansion decisions, while its uneven benefit distribution suggests further efforts are necessary to address disparities.