Changes in Health Care Access and Utilization for Low-SES Adults Aged 51–64 Years After Medicaid Expansion

ObjectivesWhether the Affordable Care Act (ACA) insurance expansions improved access to care and health for adults aged 51–64 years has not been closely examined. This study examined longitudinal changes in access, utilization, and health for low-socioeconomic status adults aged 51–64 years before and after the ACA Medicaid expansion.MethodsLongitudinal difference-in-differences (DID) study before (2010–2014) and after (2016) Medicaid expansion, including N = 2,088 noninstitutionalized low-education adults aged 51–64 years (n = 633 in Medicaid expansion states, n = 1,455 in nonexpansion states) from the nationally representative biennial Health and Retirement Study. Outcomes included coverage (any, Medicaid, and private), access (usual source of care, difficulty finding a physician, foregone care, cost-related medication nonadherence, and out-of-pocket costs), utilization (outpatient visit and hospitalization), and health status.ResultsLow-education adults aged 51–64 years had increased rates of Medicaid coverage (+10.6 percentage points [pp] in expansion states, +3.2 pp in nonexpansion states, DID +7.4 pp, p = .001) and increased likelihood of hospitalizations (+9.2 pp in expansion states, −1.1 pp in nonexpansion states, DID +10.4 pp, p = .003) in Medicaid expansion compared with nonexpansion states after 2014. Those in expansion states also had a smaller increase in limitations in paid work/housework over time, compared to those in nonexpansion states (+3.6 pp in expansion states, +11.0 pp in nonexpansion states, DID −7.5 pp, p = .006). There were no other significant differences in access, utilization, or health trends between expansion and nonexpansion states.DiscussionAfter Medicaid expansion, low-education status adults aged 51–64 years were more likely to be hospitalized, suggesting poor baseline access to chronic disease management and pent-up demand for hospital services.