Association for Public Policy Analysis & Management

The paper examines the impacts of the expansion of insurance coverage under the Affordable Care Act (ACA), including the Medicaid expansion and the mandates, on inequality of access to care among races or income levels. Using annual survey data of the Behavioral Risk Factor Surveillance System (BRFSS), changes in ‘being uninsured’, ‘having no personal doctor’, and ‘forgoing care due to cost’ are evaluated. This paper solves the problems related weights by applying new consistent weights for the regression to use data from 2009 to 2014. The weights are calculated based on the age and sex group percentage in 2010 Census data. The paper contributes on using BRFSS data to see the effect of the reform by adopting new weights.

 Multiple logistic regression analysis is used to examine the improvement of three outcome variables in 2009, the year before the ACA reform was passed, and 2014, the first year the individual mandate provision has been implemented. In order to examine short-term trends among specific groups, the paper uses interaction terms by multiplying the year dummy variable with race or income groups. Adjusting for other confounders, including age, gender, marital status, education, employment, household size, and health behaviors, the probability of insurance coverage, accessibility and affordability of health care is expected to increase. The result would suggest that the reform effectively reduce racial and income inequality in access to care.