Did Medicaid expansion close African American-white health care disparities nationwide? A scoping review

Snowden, Lonnie R.; Graaf, Genevieve; Keyes, Latocia; Kitchens, Katherine; Ryan, Andrew D.; Wallace, Nancy

doi:10.1186/s12889-022-14033-8

Cited by 13 publications

(9 citation statements)

References 50 publications

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“…[10][11][12][13] Regardless, while the uninsured rates among non-Hispanic Blacks (Blacks thereafter) and Hispanics were reduced, their uninsured rates remained substantially higher compared with Whites. 10,[13][14][15] Therefore, given the heterogeneous effect of Medicaid expansion on uninsured rates between Blacks and Hispanics compared with Whites, that CVD is the leading cause of death, 2,3 and that Blacks and Hispanics are disproportionately at risk, 1,4 it is possible that Medicaid expansion could have a differential impact on CVD mortality among Blacks and Hispanics compared with Whites.…”

mentioning

confidence: 99%

Medicaid Expansion and Racial–Ethnic and Sex Disparities in Cardiovascular Diseases Over 6 Years: A Generalized Synthetic Control Approach

Nianogo,

Zhao,

et al. 2023

Epidemiology

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Background: Studies have suggested Medicaid expansion enacted in 2014 has resulted in a reduction in overall cardiovascular disease (CVD) mortality in the United States. However, it is unknown whether Medicaid expansion has a similar effect across race–ethnicity and sex. We investigated the effect of Medicaid expansion on CVD mortality across race–ethnicity and sex. Methods: Data come from the behavioral risk factor surveillance system and the US Centers for Disease Control’s Wide-ranging Online Data for Epidemiologic Research, spanning the period 2000–2019. We used the generalized synthetic control method, a quasi-experimental approach, to estimate effects. Results: Medicaid expansion was associated with −5.36 (mean difference [MD], 95% confidence interval [CI] = −22.63, 11.91) CVD deaths per 100,000 persons per year among Blacks; −4.28 (MD, 95% CI = −30.08, 21.52) among Hispanics; −3.18 (MD, 95% CI = −8.30, 1.94) among Whites; −5.96 (MD, 95% CI = −15.42, 3.50) among men; and −3.34 (MD, 95% CI = −8.05, 1.37) among women. The difference in mean difference (DMD) between the effect of Medicaid expansion in Blacks compared with Whites was −2.18; (DMD, 95% CI = −20.20, 15.83); between that in Hispanics compared with Whites: −1.10; (DMD, 95% CI = −27.40, 25.20) and between that in women compared with men: 2.62; (DMD, 95% CI = −7.95, 13.19). Conclusions: Medicaid expansion was associated with a reduction in CVD mortality overall and in White, Black, Hispanic, male, and female subpopulations. Also, our study did not find any difference or disparity in the effect of Medicaid on CVD across race–ethnicity and sex–gender subpopulations, likely owing to imprecise estimates.

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mentioning

confidence: 99%

Medicaid Expansion and Racial–Ethnic and Sex Disparities in Cardiovascular Diseases Over 6 Years: A Generalized Synthetic Control Approach

Nianogo,

Zhao,

et al. 2023

Epidemiology

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“…Despite higher levels of poverty, undocumented immigrant families are often not eligible for numerous benefit programs, including TANF, Medicaid, and EITC . Medicaid expansion narrowed racial and ethnic disparities in health insurance coverage, but most evidence indicates that disparities in access, use, and affordability have not substantially narrowed . Black caregivers investigated by CPS are less likely to receive depression treatment compared with White caregivers .…”

Section: Discussionmentioning

confidence: 99%

“…19 Medicaid expansion narrowed racial and ethnic disparities in health insurance coverage, but most evidence indicates that disparities in access, use, and affordability have not substantially narrowed. [20][21][22] Black caregivers investigated by CPS are less likely to receive depression treatment compared with White caregivers. 23 Regardless of how equally subsidies for child care may have been distributed, large geographic disparities in child care availability exist and correlate with race and ethnicity demographics.…”

Section: Discussionmentioning

confidence: 99%

Public Benefit Programs and Differential Associations With Child Maltreatment by Race and Ethnicity

Puls,

Hall,

Boyd

et al. 2024

JAMA Pediatr

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ImportancePublic benefit programs, including state spending on local, state, and federal-state partnership programs, have consistently been associated with overall reductions in child protective services (CPS) involvement. Inequities in eligibility and access to benefit programs may contribute to varying associations by race and ethnicity.ObjectiveTo determine whether associations between state spending on benefit programs and rates of CPS investigations differ by race and ethnicity.Design, Setting, and ParticipantsThis cross-sectional ecological study used repeated state-level measures of child maltreatment from the National Child Abuse and Neglect Data System and population estimates from the US Census Bureau for all Black, Hispanic, and White children. All 50 US states from October 1, 2009, through September 30, 2019 (fiscal years 2010-2019), were included. Data were collected and analyzed from May 13, 2022, to March 2, 2023.ExposuresAnnual state spending on benefit programs per person living below the federal poverty limit, total and by the following subcategories: (1) cash, housing, and in-kind; (2) housing infrastructure; (3) child care assistance; (4) refundable earned income tax credit; and (5) medical assistance programs.Main Outcomes and MeasuresRace- and ethnicity-specific rates of CPS investigations. Generalized estimating equations, with repeated measures of states, an interaction between race and spending, and estimated incidence rate ratios (IRRs) and 95% CIs for incremental changes in spending of US $1000 per person living below the federal poverty limit were calculated after adjustment for federal spending, race- and ethnicity-specific child poverty rate, and year.ResultsA total of 493 state-year observations were included in the analysis. The association between total spending and CPS investigations differed significantly by race and ethnicity: there was an inverse association between total state spending and CPS investigations for White children (IRR, 0.94 [95% CI, 0.91-0.98]) but not for Black children (IRR, 0.98 [95% CI, 0.94-1.02]) or Hispanic children (IRR, 0.99 [95% CI, 0.95-1.03]) (P = .02 for interaction). Likewise, inverse associations were present for only White children with respect to all subcategories of state spending and differed significantly from Black and Hispanic children for all subcategories except the refundable earned income tax credit (eg, IRR for medical assistance programs for White children, 0.89 [95% CI, 0.82-0.96]; P = .005 for race and spending interaction term).Conclusions and RelevanceThese results raise concerns that benefit programs may add relative advantages for White children compared with Black and Hispanic children and contribute to racial and ethnic disparities in CPS investigations. States’ eligibility criteria and distribution practices should be examined to promote equitable effects on adverse child outcomes.

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“…Medicaid expansion provided improved insurance coverage for all racial and ethnic groups [18]. However, disparities persist based on Snowden et al [19] systematic review of 26 studies involving healthcare disparities between Black and White Americans. The research findings were mixed, as only 11 studies evaluated differences between states with and without Medicaid expansion and differences between Black and White Americans [19].…”

Section: The Disparity In Healthcare Black Vs Whitementioning

confidence: 99%

“…However, disparities persist based on Snowden et al [19] systematic review of 26 studies involving healthcare disparities between Black and White Americans. The research findings were mixed, as only 11 studies evaluated differences between states with and without Medicaid expansion and differences between Black and White Americans [19]. It is unclear whether Medicaid expansion improved for Black Americans as there remains a disparity in health coverage between Black and White Americans, with the uninsured rate being 11% and 7% in 2021 [20].…”

Section: The Disparity In Healthcare Black Vs Whitementioning

confidence: 99%

The Impact of Race on Healthcare Coverage for Women in Louisiana and Mississippi

Patton,

Najd,

Ford

2023

IJMH

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It is crucial to confront the problem of health inequity that Black women are experiencing. Black women have a higher risk of pregnancy-related complications and experience worse outcomes in cardiovascular diseases, diabetes, high blood pressure, and mental health. Even with the Affordable Care Act, Black women still may not have access to affordable health insurance. This study examines the impact of race on healthcare coverage for women in Louisiana, which expanded Medicaid, and Mississippi, which did not. The study uses a quasi-experimental analysis to compare insurance coverage across states using publicly available data from the 2010 and 2021 American Community Survey. A chi-squared test determined a significant correlation between race and insurance type in both states. Insurance coverage for Black women increased in Louisiana. Women in Mississippi made slight gains even without Medicaid expansion. Despite these gains, racial disparity among women persists. Policymakers should strive for affordable healthcare for all women, regardless of race and geography.

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Did Medicaid expansion close African American-white health care disparities nationwide? A scoping review

Cited by 13 publications

References 50 publications

Medicaid Expansion and Racial–Ethnic and Sex Disparities in Cardiovascular Diseases Over 6 Years: A Generalized Synthetic Control Approach

Medicaid Expansion and Racial–Ethnic and Sex Disparities in Cardiovascular Diseases Over 6 Years: A Generalized Synthetic Control Approach

Public Benefit Programs and Differential Associations With Child Maltreatment by Race and Ethnicity

The Impact of Race on Healthcare Coverage for Women in Louisiana and Mississippi

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