Examining the Impact of ACA Medicaid Expansion on Insurance Coverage, Access to Care and Health of Low-Income Parents.

Abstract

Objective: To examine longer-term effects of Medicaid expansion on insurance coverage, access to care, and health, and investigate heterogeneous effects across demographic characteristics of low-income parents.

Study setting and design: We estimated linear probability models for having healthcare coverage and access to care and reporting days of not good physical and mental health in the past 30 days. We adjusted for individual- and state-level factors, and state and year fixed effects. Our treatment group included low-income parents residing in Medicaid expansion states, and our control group included high-income parents residing in Medicaid expansion states and ineligible for any Affordable Care Act (ACA) subsidies. We used difference-in-differences and event-study designs.

Data sources and analytic sample: Nationally representative secondary data on self-reported insurance, access, and health status from the core component (2011-2019) of the Behavioral Risk Factor Surveillance System (BRFSS) among respondents aged 26-54 with at least one child living in the household.

Principal findings: Medicaid expansion was associated with a 13.4 percentage point (pp) increase in the probability of reporting any health insurance (p < 0.001), an 11.3 pp decline in the probability of reporting a cost barrier (p < 0.001), and a 2.4 pp decrease in the probability of reporting days in poor mental health (p = 0.028) among low-income parents. Our results also suggest parents who were married and those identifying as non-Hispanic white (relative to Hispanic and non-Hispanic other/multiple race) experienced the largest increases in health insurance coverage.

Conclusions: While Medicaid expansions improved insurance coverage, access to care, and health status among low-income parents, disparities persisted and, in some cases, widened. These findings have significant implications for policymakers as they consider policies aimed at increasing access to care.