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

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

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).

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.

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.