Reducing Disparities In Access To Health Care

We commend Kevin Griffith and coauthors for highlighting an important result of Medicaid expansion—the reduction of long-standing socioeconomic disparities in access to care (Aug 2017).

In our analysis of data for the period 2011–15 from the Behavioral Risk Factor Surveillance System, we observed similar reductions in income-related disparities. We used household size and income to impute income as a percentage of the federal poverty level.^1,2 Respondents were then categorized as low-income (incomes no more than 138% of the federal poverty level) or high-income (incomes at least 400 percent of the federal poverty level) to assess changes in disparities.

We found that the disparity in coverage between income groups fell from 35 percent to 22 percent in states that expanded eligibility for Medicaid under the Affordable Care Act and from 43 percent to 36 percent in nonexpansion states. We found similar reductions in disparities in other access to care variables: having a personal doctor and delaying care due to cost. Disparity reductions in expansion states were significantly greater than reductions in nonexpansion states for each outcome (p<0.05). As the authors discussed, it is important to note the compounding effect of not expanding Medicaid eligibility in states where baseline disparities were already higher than their expansion counterparts.

Given the ongoing discussions about Medicaid’s future, it is worth emphasizing an often-overlooked outcome of Medicaid expansion: the attenuation of disparities in access to health care.