Changes in Health Care Access by Race, Income, and Medicaid Expansion During the Covid-19 Pandemic

Datos Bibliográficos

ID9100166
AutoresSamantha G Auty (0000-0002-0776-4025, Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, autor de correspondencia), Monica S Aswani (0000-0001-7835-2004, University of Alabama at Birmingham), Rafik N Wahbi (Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, CA), Rafik Wahbi (University of California, Los Angeles), Kevin N Griffith (0000-0002-8304-8602, Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN)
Año2023
Volumen61
Número1
Páginas45-49
Fecha de publicación2023-01-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001788
PMID36477619
OpenAlexW4310905481
IdiomaEN
Citas recibidas2
Referencias citadas15

BACKGROUND: The intersecting crises of the COVID-19 pandemic, job losses, and concomitant loss of employer-sponsored health insurance may have disproportionately affected health care access within minorized and lower-socioeconomic status communities. OBJECTIVE: To describe changes in access to care during the COVID-19 pandemic, stratified by race/ethnicity, household income, and state Medicaid expansion status. RESEARCH DESIGN: We used interrupted time series and difference-in-differences regression models, controlling for respondent characteristics and preexisting trends. SUBJECTS: Data were extracted for all adults aged 18-64 surveyed in the 2015-2020 Behavioral Risk Factor Surveillance System (N=1,731,699) from all 50 states and the District of Columbia. MEASURES: Our outcomes included indicators for whether respondents had any health insurance coverage or avoided seeking care because of cost within the prior year. The primary exposure was the onset of the COVID-19 pandemic in the United States in March 2020. RESULTS: The pandemic was associated with a 1.2 percentage point (pp) decline in uninsurance for Medicaid expansion states (95% CI, -1.8, -0.6); these reductions were concentrated among respondents who were Black, multiracial, or low income. The rates of uninsurance were generally stable in nonexpansion states. The rates of avoided care because of cost fell by 3.5 pp in Medicaid expansion states (95% CI, -3.9, -3.1), and by 3.6 pp (95% CI, 4.3-2.9) in nonexpansion states. These declines were concentrated among respondents who were Hispanic, Other Race, or low income. CONCLUSIONS: Our findings reinforce the value of Medicaid expansion as one tool to improve access to health insurance and care for marginalized and vulnerable populations

Behavioral Risk Factor Surveillance System · Coronavirus disease 2019 (COVID-19) · Economic growth · Economics · Environmental health · Ethnic group · Health care · Medicaid · National Health Interview Survey · Pandemic · Political science · Population · Respondent · Socioeconomic status · Demography · Food Security and Health in Diverse Populations · Geriatric Care and Nursing Homes · Healthcare Policy and Management · Medicine · Gerontology