Racial/Ethnic Differential Effects of Medicaid Expansion on Health Care Access

Yue, Dahai; Rasmussen, Petra W.; Ponce, Ninez A.

doi:10.1111/1475-6773.12834

Cited by 87 publications

(86 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Further, gains in any prescription drug fill were largest among Black, non‐Hispanic and Hispanic individuals, but changes in total prescription drug costs were largest among white, non‐Hispanic individuals. Our data are consistent with population‐level analyses—while Medicaid enrollment improves care across racial and ethnic groups, Medicaid alone is unlikely to eliminate racial/ethnic disparities in access to care and health in the United States …”

Section: Discussionsupporting

confidence: 85%

See 1 more Smart Citation

Medicaid enrollment among previously uninsured Americans and associated outcomes by race/ethnicity—United States, 2008‐2014

Winkelman

Segel

Davis

2018

Health Services Research

View full text Add to dashboard Cite

Objectives To examine the person‐level impact of Medicaid enrollment on costs, utilization, access, and health across previously uninsured racial/ethnic groups. Data Source Medical Expenditure Panel Survey, 2008‐2014. Study Design We pooled multiple 2‐year waves of data to examine the direct impact of Medicaid enrollment among uninsured Americans. We compared changes in outcomes among nonpregnant, uninsured individuals who gained Medicaid (N = 963) to those who remained uninsured (N = 9784) using a difference‐in‐differences analysis. Principal Findings Medicaid enrollment was associated with significant increases in total health care costs and total prescription drug costs and a significant decrease in out‐of‐pocket costs. Among those who gained Medicaid, prescription drug use increased significantly relative to those who remained uninsured. Medicaid enrollment was also associated with a significant increase in reporting a usual source of care, a decrease in foregone care, and significant improvements in severe psychological distress. Changes in total prescription drug costs and total prescription drug fills differed significantly across each racial/ethnic group. Conclusions Among a national sample of uninsured individuals, Medicaid enrollment was associated with substantial favorable changes in out‐of‐pocket costs, prescription drug use, and access to care. Our findings suggest Medicaid is an important tool to reduce insurance‐related disparities among Americans.

show abstract

Section: Discussionsupporting

confidence: 85%

“…disparities in access to care and health in the United States. 12,21,22,35 In our primary multivariable analysis, enrollment in Medicaid was not associated with statistically significant changes in ED use or inpatient hospitalizations. However, these results should be interpreted with some caution.…”

Section: Sensitivity Analysesmentioning

confidence: 70%

Medicaid enrollment among previously uninsured Americans and associated outcomes by race/ethnicity—United States, 2008‐2014

Winkelman

Segel

Davis

2018

Health Services Research

View full text Add to dashboard Cite

show abstract

“…Second, in contrast to the BRFSS, the ACS allows us to examine how changes in sources of coverage, such as employer‐sponsored and individually purchased private coverage and Medicaid, drove any changes in disparities. Third, in contrast to other recent work, our approach allows us to estimate the impact of the fully implemented ACA, rather than just focusing on the Medicaid expansion. Fourth, we examine disparities along a new dimension: residence in rural vs. urban locations.…”

Section: Introductionmentioning

confidence: 99%

“…9 Another paper, also using data through 2015, finds that the Medicaid expansion led to smaller gains among low-income Hispanics than other low-income individuals, implying a widened disparity. 10 Other papers provide evidence that the Medicaid expansion increased insurance coverage among those with low incomes or levels of education, implying reduced disparities relative to individuals with higher socioeconomic status. 11,12 One study's focus is on the impact of the ACA in a single state, Kentucky, finding that much of the reduction in the state's uninsured rate is due to large coverage gains from areas with higher concentrations of poverty.…”

mentioning

confidence: 99%

“…One recent study examines the effect on the uninsured rate after three years using the BRFSS, but does not specifically examine disparities. 14 Third, in contrast to other recent work, 9,10 our approach allows us to estimate the impact of the fully implemented ACA, rather than just focusing on the Medicaid expansion. Fourth, we examine disparities along a new dimension: residence in rural vs. urban locations.…”

mentioning

confidence: 99%

See 1 more Smart Citation

The three‐year impact of the Affordable Care Act on disparities in insurance coverage

Courtemanche

Marton

Ukert

et al. 2018

Health Services Research

View full text Add to dashboard Cite

Objective To estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on disparities in insurance coverage after three years. Data Source The 2011‐2016 waves of the American Community Survey (ACS), with the sample restricted to nonelderly adults. Design We estimate a difference‐in‐difference‐in‐differences model to separately identify the effects of the nationwide and Medicaid expansion portions of the ACA using the methodology developed in the recent ACA literature. The differences come from time, state Medicaid expansion status, and local area pre‐ACA uninsured rates. In order to focus on access disparities, we stratify our sample separately by income, race/ethnicity, marital status, age, gender, and geography. Principal Findings After three years, the fully implemented ACA eliminated 43% of the coverage gap across income groups, with the Medicaid expansion accounting for this entire reduction. The ACA also reduced coverage disparities across racial groups by 23%, across marital status by 46%, and across age‐groups by 36%, with these changes being partly attributable to both the Medicaid expansion and nationwide components of the law. Conclusions The fully implemented ACA has been successful in reducing coverage disparities across multiple groups.

show abstract

Association of State Medicaid Expansion Status With Low Birth Weight and Preterm Birth

Brown

Moore

Felix

et al. 2019

JAMA

107

View full text Add to dashboard Cite

IMPORTANCE Low birth weight and preterm birth are associated with adverse consequences including increased risk of infant mortality and chronic health conditions. Black infants are more likely than white infants to be born prematurely, which has been associated with disparities in infant mortality and other chronic conditions. OBJECTIVE To evaluate whether Medicaid expansion was associated with changes in rates of low birth weight and preterm birth outcomes, both overall and by race/ethnicity. DESIGN, SETTING, AND PARTICIPANTS Using US population-based data from the National Center for Health Statistics Birth Data Files (2011-2016), difference-indifferences (DID) and difference-indifference in differences (DDD) models were estimated using multivariable linear probability regressions to compare birth outcomes among infants in Medicaid expansion states relative to non-Medicaid expansion states and changes in relative disparities among racial/ethnic minorities for singleton live births to women aged 19 years and older. EXPOSURES State Medicaid expansion status and racial/ethnic category. MAIN OUTCOMES AND MEASURES Preterm birth (<37 weeks' gestation), very preterm birth (<32 weeks' gestation), low birth weight (<2500 g), and very low birth weight (<1500 g). RESULTS The final sample of 15 631 174 births (white infants: 8 244 924, black infants: 2 201 658, and Hispanic infants: 3 944 665) came from the District of Columbia and 18 states that expanded Medicaid (n = 8 530 751) and 17 states that did not (n = 7 100 423). In the DID analyses, there were no significant changes in preterm birth in expansion relative to nonexpansion states (preexpansion to postexpansion period, 6.80% to 6.

show abstract

Racial/Ethnic Differential Effects of Medicaid Expansion on Health Care Access

Abstract: 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.

Cited by 87 publications

References 23 publications

Medicaid enrollment among previously uninsured Americans and associated outcomes by race/ethnicity—United States, 2008‐2014

Medicaid enrollment among previously uninsured Americans and associated outcomes by race/ethnicity—United States, 2008‐2014

The three‐year impact of the Affordable Care Act on disparities in insurance coverage

Association of State Medicaid Expansion Status With Low Birth Weight and Preterm Birth

Contact Info

Product

Resources

About