Medicaid Expansion Produces Mixed Results on Health Disparities

Medicaid expansion has had mixed results in reducing health disparities and advancing coverage, utilization, and quality of care equity, an issue brief from Kaiser Family Foundation revealed.

The researchers reviewed 65 studies with publication dates spanning January 2014 to July 2020. The studies covered the effects of Medicaid expansion on health disparities in four major areas: healthcare coverage, access to care and utilization, patient outcomes and quality of care, and payer mix as well as other economic impacts.

Primarily, the literature focused on disparities for Black and Hispanic communities.

When it came to disparities in healthcare coverage, the research found that Medicaid expansion did not eliminate this inequality, but the majority of the studies discovered that having a larger insurance safety net did diminish these disparities.

Nearly three-quarters of the studies on healthcare coverage disparities (21 studies out of 29) found that Medicaid diminished insurance disparities. This is key information as COVID-19 continues to increase racial coverage disparities.

“Some of these studies had mixed results; for example, finding disparities narrowed for one racial/ethnic group but that expansion had no effect on or widened disparities for another group,” the researchers clarified.

“Similarly, findings sometimes varied by measure; for example, some studies found disparities in uninsured rates decreased but those in Medicaid coverage did not, or vice versa.”

The studies that found that Medicaid expansion had no explicitly positive or negative effects on healthcare coverage mostly pulled data from the first year of the expansion or were trained on a very targeted group.

Black and Hispanic populations were slightly more likely than other minority populations to see an increase in healthcare coverage as a result of Medicaid expansion. Results for other populations of color were mixed. The positive increase in coverage for Black and Hispanic populations was especially prominent in populations with cancer.

“Study authors explain that racial/ethnic disparities in cancer care and outcomes are longstanding and may be mitigated by increases in insurance coverage,” the brief summarized.

The brief also examined the disparities in payer mix and economic impacts. The research in this area was not robust, however some studies indicated that Medicaid expansion might lead to less disparity in reimbursement for minority patients. Some studies have also indicated that Medicaid expansion may lead to employment gains in minority communities.

Disparities in access to care and care utilization did improve under Medicaid expansion, the studies found. However, they did not report a decrease in disparities from before the Affordable Care Act went into effect.

Fewer than half of the studies (10 out of 24 studies) found that Medicaid expansion led to a reduction in access to care disparities for certain groups. Two of the studies discovered that disparities widened as access to care or care utilization improved among White individuals, as opposed to minorities.

The studies did not see a link between Medicaid expansion and less racial disparity in access to primary care. The affordability of care disparity did not significantly decline, though it did improve in some groups.

Although coverage disparities for cancer patients who are people of color may have diminished, expansion had no effect on cancer preventive care and treatment disparities.

Some studies found that Medicaid expansion led to lower utilization disparities for one racial group in certain specific services, but most studies found no significant effect on care utilization disparities.

In regards to health outcomes—the final category which these studies covered—Medicaid expansion showed some strong results. In particular, the studies found that infant and maternal health disparities for Black and Hispanic individuals decreased under Medicaid expansion. Studies did not find increased patient outcome disparities under Medicaid expansion.

Medicaid expansion has also been shown to improve women’s health outcomes overall.

“Together these findings illustrate that the Medicaid expansion has contributed to reductions in longstanding racial disparities in health coverage,” the researchers concluded.

“They further suggest that, while increased coverage can help improve access to care and contribute to improvements in health, coverage alone is not enough to eliminate disparities in these measures.”