Differential Effects Of Medicaid Expansion On Racial/ethnic Disparities In Primary Care Access

Janet Yim

This thesis is restricted to Yale network users only. It will be made publicly available on 08/28/2021


By providing health insurance to low-income and disabled children and adults, the United States’ Medicaid program increases health care access and utilization by those with limited access to affordable private insurance. To increase coverage, the Affordable Care Act (ACA) helped fund state expansions of Medicaid’s eligibility criteria to include low-income adults with incomes up to 138% of the Federal Poverty level. This paper examines the differential effects of Medicaid expansion on racial/ethnic disparities in primary care access using a quasi-experimental differences-in-differences design. Regression analyses consider low income adults (defined as below 138% FPL) ages 19-64. When analyzing both short term and longer-term effects, we found that those in expansion states experienced significant gains in health insurance, having personal doctors, and having the ability to afford health care post Medicaid expansion. There were no significant effects in regards to flu vaccination rates. We initially found that Medicaid expansion did not have differential effects between racial and ethnic groups on health insurance coverage. However, after controlling for state-by-race and year-by-race fixed effects, we found that non-Hispanic blacks and Hispanics benefitted significantly less than non-Hispanic whites (7.39 percentage points and 5.66 percentage points respectively). We also found that non-Hispanic blacks benefitted significantly less than non-Hispanic whites when examining affordability of care after Medicaid expansion. We conclude that the benefits of Medicaid expansion were not experienced equally across different racial and ethnic groups. Further research should evaluate more disaggregated racial and ethnic group categories to better understand the disparities at play to formulate tailored policy solutions and to better examine the “chilling effect”.