Disparities in the Impact of Medicaid Expansion on Adults in Poverty

Yan, Brandon W. (2017). The Impact of Medicaid Expansion on Health Care Access, Utilization, and Health. Honors thesis, Duke University, 2017

26 Pages Posted: 8 Aug 2019 Last revised: 11 Aug 2019

See all articles by Brandon W. Yan

Brandon W. Yan

University of California, San Francisco (UCSF) - Institute for Health Policy Studies; University of California, San Francisco (UCSF) - School of Medicine; Duke University - Sanford School of Public Policy

Frank A. Sloan

Duke University - Center for Health Policy, Law and Management; Duke University, Fuqua School of Business-Economics Group; Duke University - Department of Economics; National Bureau of Economic Research (NBER)

Chien-Wen Tseng

University of Hawaii John A. Burns School of Medicine, Department of Family Medicine and Community Health

John Boscardin

University of California, Los Angeles (UCLA)

R. Adams Dudley

University of California, San Francisco (UCSF) - Institute for Health Policy Studies

Date Written: April 1, 2019

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.

Keywords: health care reform, Medicaid, health disparities, insurance coverage, utilization, preventive care, Affordable Care Act

Suggested Citation

Yan, Brandon W. and Sloan, Frank A. and Tseng, Chien-Wen and Boscardin, John and Dudley, R. Adams, Disparities in the Impact of Medicaid Expansion on Adults in Poverty (April 1, 2019). Yan, Brandon W. (2017). The Impact of Medicaid Expansion on Health Care Access, Utilization, and Health. Honors thesis, Duke University, 2017, Available at SSRN: https://ssrn.com/abstract=3423000 or http://dx.doi.org/10.2139/ssrn.3423000

Brandon W. Yan (Contact Author)

University of California, San Francisco (UCSF) - Institute for Health Policy Studies ( email )

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University of California, San Francisco (UCSF) - School of Medicine ( email )

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Duke University - Sanford School of Public Policy ( email )

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Frank A. Sloan

Duke University - Center for Health Policy, Law and Management ( email )

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919-684-6246 (Fax)

Duke University, Fuqua School of Business-Economics Group ( email )

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Duke University - Department of Economics ( email )

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National Bureau of Economic Research (NBER)

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Chien-Wen Tseng

University of Hawaii John A. Burns School of Medicine, Department of Family Medicine and Community Health ( email )

651 Ilalo St
Honolulu, HI 96813
United States

John Boscardin

University of California, Los Angeles (UCLA) ( email )

405 Hilgard Avenue
Box 951361
Los Angeles, CA 90095
United States

R. Adams Dudley

University of California, San Francisco (UCSF) - Institute for Health Policy Studies ( email )

3180 18th St., Suite 302
San Francisco, CA 94110
United States

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