Impact of Medicaid Expansion on Healthcare Access Among Individuals Living With Chronic Diseases

Abstract

Introduction: The Affordable Care Act's Medicaid expansion has been found to increase healthcare access among low-income individuals in the general population. Fewer studies have explored the impact of Medicaid expansion on healthcare access among those living with chronic diseases. It is also unclear whether the impact of Medicaid expansion varies across levels of educational attainment or poverty among this subgroup. This study investigates the impact of Medicaid expansion on healthcare access among adults aged 18-64 years living with chronic diseases, as well as its variations across educational attainment and federal poverty levels.

Methods: The 2011-2017 Behavioral Risk Factor Surveillance System data were used. Difference-in-difference analyses explored the impact of Medicaid expansion on healthcare access (health insurance coverage, routine checkup, having a personal doctor, and cost-related delayed care within the past 1 year) among individuals living with chronic diseases. Analyses were also stratified by levels of educational attainment and quartiles of the federal poverty level. Data were analyzed between February and November 2019.

Results: Medicaid expansion was associated with increased health insurance coverage (β=0.27, 95% CI=0.16, 0.38), increased likelihood of having a routine checkup (β=0.12, 95% CI=0.04, 0.22) within the past 1 year, increased likelihood of having a personal doctor (β=0.08, 95% CI=0.01, 0.12), and decreased likelihood of reporting cost-related delayed care (β=-0.10, 95% CI=-0.19, -0.02). Medicaid expansion was associated with increased health insurance coverage across all levels of educational attainment and federal poverty level quartiles.

Conclusions: Medicaid expansion increased healthcare access for low-income individuals living with chronic diseases.