Table 2. Changes in Coverage and Access to Care in 2020 vs 2018 to 2019 in Association With Medicaid Expansion^a.

Outcome	Arkansas, Kentucky, and Louisiana (Medicaid expansion states)		Texas (nonexpansion state)		Difference-in-differences estimate
	2020 vs 2018-2019, %	P value	2020 vs 2018-2019, %	P value	Net change, % (95% CI)	P value
Coverage
Uninsured	2.5	.27	7.4	.01	−4.9 (−11.4 to 1.6)	.14
Medicaid or marketplace	0.1	.97	−4.3	.09	4.4 (−2.4 to 11.2)	.22
Employer-sponsored insurance	−1.7	.44	−0.2	.90	−1.5 (−7.0 to 4.0)	.59
Other health insurance	−3.9	.07	−5.1	.01	1.2 (−4.0 to 6.3)	.66
Access to care
Has a personal physician	−11.3	<.001	−14.0	<.001	2.7 (−5.0 to 10.4)	.49
Usual source of care	−5.1	.04	−7.0	.003	1.9 (−4.1 to 8.0)	.53
Regular care for chronic conditionb	−10.5	<.001	−10.3	.03	−0.2 (−10.8 to 10.4)	.97
Affordability of care
Skipped medication because of cost	−9.0	<.001	−13.1	<.001	4.1 (−2.7 to 10.9)	.23
Trouble paying medical bills	−9.4	.001	−5.4	.08	−4.0 (−11.6 to 3.5)	.30
Cost-related delay in care	−5.2	.03	2.3	.56	−7.5 (−16.4 to 1.5)	.10

^a Results show survey-weighted difference-in-differences estimates for expansion states (Arkansas, Kentucky, and Louisiana) vs Texas. All analyses adjusted for sex, age, race and ethnicity, marital status, education, urban vs rural residence, and state. The sample contained 7515 US citizens ages 19 to 64 years with family incomes at or below 138% of the federal poverty level (minus item nonresponse for each specific outcome), except where otherwise noted.

^b For the regular care for chronic condition measure, the sample was limited to patients who reported at least 1 of the following conditions: hypertension, heart attack/coronary artery disease, stroke, asthma/chronic obstructive pulmonary disease, diabetes, depression or anxiety, cancer, and substance use disorder (n = 5687).