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Medicaid and
CHIP
Payment
and Access Commission
www
.macpac.gov
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Guth, M., S. Artiga, & O. Pham. 2020. Effects of the ACA Medicaid expansion on racial disparities in health
and health care. Washington, DC: Kaiser Family Foundation (KFF).
https://www.kff.org/report-
section/effects-of-the-aca-medicaid-expansion-on-racial-disparities-in-health-and-health-care-issue-brief/.
This brief reviewed the literature on the effects of Medicaid expansion on racial disparities in four areas:
coverage, access to and use of care, health outcomes and quality, and payer mix. In health coverage, most
studies found that expansion helped narrow but did not eliminate disparities. In access and use of care,
most studies found that while expansion was generally associated with improvements, there was limited
evidence of reduction in disparities. In outcomes and quality, studies found that expansion mostly
narrowed disparities, particularly in infant and maternal health. Finally studies also suggested that
expansion narrowed disparities in economic well-being and reimbursement patterns.
Howell, E., S. Decker, S. Hogan, et. al. 2010. Declining child mortality and continuing racial disparities in
the era of the Medicaid and SCHIP insurance coverage expansions. American Journal of Public Health
100, no. 12: 2500-2506.
https://dx.doi.org/10.2105%2FAJPH.2009.184622.
This study used data from the National Center for Health Statistics' multiple-cause-of-death files from
1985 to 2004 to examine trends in national childhood mortality and racial disparities in relation to
Medicaid and CHIP eligibility expansions. The study found that although child mortality substantially
declined, mortality ratios between Black and white children did not change. The study also found that
eligibility expansions were significantly associated with declines in external cause mortality but did not
affect racial disparities.
Langellier, B.A., J. Guerney de Zapien, C. Rosales, et.al. 2014. State Medicaid expansion, community
interventions, and health care disparities in a United States- Mexico border community. American Journal
of Public Health 104, no. 8: e94-e100.
https://doi.org/10.2105/AJPH.2014.302013.
This study used data from a local survey (Douglas Community Health Survey) in 1998 and 2010 to examine
whether Arizona's pre-ACA Medicaid expansion in tandem with a number of community-level programs
(such as diabetes education) affected access to and use of health care services in a primarily Mexican-
American community. The study found that insurance coverage increased from 66 percent to 82 percent.
Study participants in 2010 were also more likely to have a usual source of care, to have visited a provider in
the past year, and to have been screened for diabetes and hypertension. Participants with the lowest
education levels had the highest increases in health insurance coverage and use of services, largely
eliminating the gap in coverage and use between themselves and participants with higher levels of
education.
Lee, H. & F. Porell. 2020. The effect of the Affordable Care Act Medicaid expansion on disparities in
access to care and health status. Medical Care Research and Review 77, no. 5: 461-473.
https://doi.org/10.1177%2F1077558718808709.
This study used data from the BRFSS from 2011 to 2016 to estimate the effect of Medicaid expansion on
racial and ethnic disparities on a number of variables. It found that while expansion increased coverage at
a greater rate for Black individuals than white individuals, there are still noticeable disparities in access
and quality. Expansion positively affected access and health outcomes for white childless adults but had
few positive effects for their Black and Hispanic counterparts. Variables examined included having: no
usual source of care, unmet needs due to cost, no annual checkup, self-perceived health status that was
fair or poor, and how many of the past 30 days a respondent was not in good health.