Medicaid expansion and health care access for individuals with obesity in the United States.

Abstract

This study aimed to evaluate associations of Medicaid expansion with health care access for adults with obesity and to explore racial/ethnic differences in these changes in health care access. Using 2011 to 2017 Behavioral Risk Factor Surveillance System data, the study compared health care access measures among adults who were aged ≥18 years and who had BMI ≥ 30 kg/m2 and household income ≤ 138% of the federal poverty line by state Medicaid expansion status using a difference-in-differences approach with logistic regression. The authors further stratified the main analysis by race/ethnicity. Medicaid expansion was associated with improvements in health care access, including lower proportions of those without a usual source of care (-3.6%, 95% confidence interval [CI]: -5.8% to -1.4%, p < 0.01) and cost as a barrier to medical care (-4.5%, 95% CI: -7.0% to -1.9%, p < 0.01). No significant changes were found in routine medical checkups in the last year (-1.8%, 95% CI: -4.4% to 0.8%, p=0.12). However, across these measures, Medicaid expansion was consistently associated with better access among non-Hispanic White adults (-6.0% to -7.9%, p < 0.01) and not at all among non-Hispanic Black and Hispanic adults (p > 0.05). Medicaid expansion was associated with significant improvements in health care access among adults with obesity, but these improvements were variable across race and ethnicity.