Study: Medicaid expansion has left low-income Hispanic parents behind

The Affordable Care Act (ACA, informally known as Obamacare) was signed into law in 2010 as part of the most significant restructuring of U.S. health care coverage since the introduction of Medicare and Medicaid 45 years earlier.

One of its main outcomes was the expansion of Medicaid, and studies have found that this helped increase insurance coverage, reduce barriers to access and improve health outcomes among low-income adults.

Now, however, a new study by health policy experts with the Texas A&M University School of Public Health has revealed an area where Medicaid expansion has not made as much progress as expected—and one with significant policy implications.

“We found that Medicaid expansion did not reduce disparities in health insurance coverage or access to care among low-income parents,” said Elena Andreyeva, PhD, who led the study, which was published in Health Services Research. “In fact, the gap between low-income Hispanic parents and other racial and ethnic groups actually increased after Medicaid expansion.”

This suggests that Hispanic parents have more barriers to getting Medicaid compared to other groups. Andreyeva said this is potentially because of their immigration status, noting that more than 71 percent of undocumented individuals in the United States were born in Latin America.

Andreyeva and colleagues Hannah Rochford, PhD, and Daniel Marthey, PhD—all with the Department of Health Policy and Management—examined the effect of ACA Medicaid expansion on self-reported insurance coverage, access to care, and mental and physical health of low-income parents residing in states that adopted Medicaid expansion.

Their study analyzed 2011-2019 data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System, a nationwide survey that collects data on health and health-related behaviors from residents in all 50 states.

To address concerns that emerged from previous studies, the researchers compared low- and high-income parents living in expansion states. They also explored how Medicaid expansion affected demographic subgroups of low-income parents and changed access to care and health.

Their study grouped low-income parents residing in Medicaid expansion states as the treatment group. For comparison, the control group included high-income parents residing in Medicaid expansion states who were not eligible for any ACA subsidies.

After adjusting for individual- and state-level factors—as well as state and year fixed effects—the researchers used three measures for access to care: whether respondents had a primary care physician, whether they had skipped needed health care in the past 12 months due to cost, and whether they had a routine check-up in the previous year. Health status was measured by the number of days in the past month that participants reported experiencing poor mental or physical health.

Statistical analyses revealed that Medicaid expansion was associated with a 13.4 percentage point increase in the probability of reporting any health insurance, an 11.3 percentage point decline in the probability of reporting a cost barrier, and a 2.4 percentage point decrease in the probability of reporting days in poor mental health among low-income parents.

In addition, the results suggested that parents who were married and those identifying as non-Hispanic white experienced the largest increases in health insurance coverage.

“These findings have significant implications for policymakers,” Andreyeva said. “Increasing health care access will require policy interventions that go beyond simply expanding Medicaid eligibility for low-income parents.”