Differential impact of recent Medicaid expansions by race and ethnicity

Objective. Between 1989 and 1995, expansions in Medicaid eligibility provid ed publicly financed health insurance to an additional 7 million poor and n ear-poor children. It is not known whether these expansions affected childr en's insurance coverage, use of health care services, or health status diff erently, depending on their race/ethnicity. The objective of this study was to examine, by race/ethnicity, the impact of the recent Medicaid expansion s on levels of uninsured individuals, health care service utilization, and health status of the targeted groups of children. Methods. Using a stratified set of longitudinal data from the National Heal th Interview Surveys of 1989 and 1995, we compared changes in measures of h ealth insurance coverage, health services utilization, and health status fo r poor white, black, and Hispanic 1- to 12-year-old children. To control fo r underlying trends over time, we subtracted 1989 to 1995 changes in these outcomes among nonpoor children from changes among the poor children for ea ch race/ethnicity group. Measures of coverage included uninsured rates and Medicaid rates. Utilization measures included annual probability of visitin g a doctor, annual number of doctor visits, and annual probability of hospi talization. Health status measures included self-reported health status and number of restricted-activity days in the 2 weeks before the interview. Di fferences in means were analyzed with the use of Student's t tests accounti ng for the clustering sample design of the National Health Interview Survey s. Results. Among poor children between 1989 and 1995, uninsured rates decline d by 4 percentage points for whites, 11 percentage points for blacks, and 1 9 percentage points for Hispanics. Medicaid rates for these groups increase d by 16 percentage points, 22 percentage points, and 23 percentage points, respectively. With respect to utilization, the annual probability of seeing a physician increased 7 percentage points among poor blacks and Hispanics but only 1 percentage point among poor whites (not significant) for childre n in good, fair, or poor health. Among those in excellent or very good heal th, the respective increases were 1 percentage point for poor whites (not s ignificant), 7 percentage points for poor blacks, and 3 percentage points f or poor Hispanics (not significant). Significant increases in numbers of do ctor visits per year were recorded only for poor Hispanics who were in exce llent or very good health, whereas significant decreases in hospitalization s were recorded for Hispanics who were in good fair or poor health. Measure s of health status remained unchanged for poor children over time. The reco rded decreases in uninsured rates and increases in Medicaid coverage remain ed robust to adjustments for underlying trends for all 3 race/ethnicity gro ups. With respect to adjusted measures of utilization and health status, th e only significant differences found were among poor blacks who were in goo d, fair, or poor health and who registered increases in the likelihood of h ospitalization and in poor Hispanics who were in excellent or very good hea lth and who registered decreases in the numbers of restricted-activity days . Conclusions. Recent expansions in the Medicaid program from 1989 to 1995 pr oduced greater reductions in uninsured rates among poor minority children t han among poor white children. Regardless of race/ethnicity, poor children did not seem to experience significant changes during the period of the exp ansions in either their level of health service utilization or their health status.