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Objectives <p>This study aims to examine the effect of Medicaid expansion on access and disparities in primary care following passage of the Affordable Care Act.</p> Data Source <p>A 2013–2016 audit of a national random sample of US primary care physicians was used</p> Study Design <p>We analyzed new patient appointment data from calls to 2574 physicians made before and after the quasi-experiment created by Medicaid expansion. Simulated patients were differentiated by race/ethnicity (Black, Hispanic, White) and gender (male and female).</p> Principal Findings <p>In 2013, compared to White men, Hispanic women were at a − 19 (95% CI − 36, − 2) and − 23 (95% CI − 44, − 1) percentage point disadvantage in probability of an appointment offer in expansion and non-expansion states, respectively. Post Medicaid expansion offers to Hispanic women increased by 37 percentage points (95% CI 21, 53) and offers to Black women increased by 21 percentage points (95% CI 5, 38) in expansion states. By 2016, offers to Hispanic and Black men in expansion states rose. Hispanic women remained at a − 16 percentage-point disadvantage (95% CI − 26, − 6) relative to White men in non-expansion states.</p> Conclusion <p>Improved access to primary care and reduced racial/ethnic and gender disparities following earlier Medicaid expansions suggest that further expansions may increase access and reduce disparities.</p>

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The Effect of Medicaid Expansion on Racial/Ethnic and Gender Disparities in Access to Primary Care among Medicaid Patients

  • 期刊论文

  • 发表日期：

    2025年4月7日

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  • Sarah Tinkler,
  • Brigham Walker,
  • Janna Wisniewski,
  • Raven Susu Mago,
  • Miron Stano,
  • Rajiv Sharma

摘要

Objectives

This study aims to examine the effect of Medicaid expansion on access and disparities in primary care following passage of the Affordable Care Act.

Data Source

A 2013–2016 audit of a national random sample of US primary care physicians was used

Study Design

We analyzed new patient appointment data from calls to 2574 physicians made before and after the quasi-experiment created by Medicaid expansion. Simulated patients were differentiated by race/ethnicity (Black, Hispanic, White) and gender (male and female).

Principal Findings

In 2013, compared to White men, Hispanic women were at a − 19 (95% CI − 36, − 2) and − 23 (95% CI − 44, − 1) percentage point disadvantage in probability of an appointment offer in expansion and non-expansion states, respectively. Post Medicaid expansion offers to Hispanic women increased by 37 percentage points (95% CI 21, 53) and offers to Black women increased by 21 percentage points (95% CI 5, 38) in expansion states. By 2016, offers to Hispanic and Black men in expansion states rose. Hispanic women remained at a − 16 percentage-point disadvantage (95% CI − 26, − 6) relative to White men in non-expansion states.

Conclusion

Improved access to primary care and reduced racial/ethnic and gender disparities following earlier Medicaid expansions suggest that further expansions may increase access and reduce disparities.