Association for Public Policy Analysis & Management

In 2010, the Affordable Care Act (ACA) was passed including expanded eligibility for Medicaid. This Medicaid expansion was implemented for people with income up to 138 percent of the federal poverty level (FPL) in 2014 except those in non-expansion states. Medicaid expansion is enabling low-income people to overcome significant financial barriers to using health care services. This coverage expansion will improve access to medical care, and is expected to improve health status for the target population who gained coverage benefits. While previous literature has significant findings on the impacts of the coverage expansion on access to care, it has inconsistent findings on the relevance of health insurance to inequalities in access to care and health status.

The goal of this study is to establish the relevance of health insurance to inequalities in access to care and health status by examining the impact of the 2010 Medicaid expansion under the ACA. Changes in health insurance status will affect the differences in access to care or health status among income and racial/ethnic subgroups. This study uses difference in differences (DinD) analysis using a quasi-experimental design, based on the Behavioral Risk Factor Surveillance (BRFSS) data. This study examines the changes in the following four outcomes and inequalities in the outcomes among racial/ethnic and income subgroups: 1) insurance status; 2) usual source of care; 3) unmet needs due to cost; and 4) self-reported health status. In addition, this study adopts expansion states as a treatment group and non-expansion states as a comparison group.

This analysis is expected to contribute to the scholarly literature on the role of the health insurance using a quasi-experimental research design and state/federal health policy in mitigating inequalities in access to care and health status.