Racial/ethnic disparities in health insurance and differences in visit type for a population of patients with diabetes after medicaid expansion

Heather Angier, David Ezekiel-Herrera, Miguel Marino, Megan Hoopes, Elizabeth A. Jacobs, Jennifer Devoe, Nathalie Huguet

Research output: Contribution to journalArticle

2 Scopus citations


This quasi-experimental study evaluated racial/ethnic disparities in health insurance and differences in visits post-versus pre-Affordable Care Act (ACA) Medicaid expansion. We utilized electronic health record data from a population of patients with diabetes aged 19–64 seen in community health centers (CHCs). We used generalized estimating equation Poisson models to estimate incidence rates of insurance type and visits post-(1/1/2014– 12/31/2015) versus pre-(1/1/13–12/31/13) ACA, stratified by racial/ethnic group. We assessed difference-in-differences (DD) and difference-in-difference-in-differences (DDD). The relative disparity in uninsured visits increased between Hispanic and non-Hispanic Whites in expansion states (DD=1.93; 95% CI=1.41, 2.64); the magnitude was greater in expansion compared with non-expansion states (DDD=1.84, 95% CI=1.32, 2.56), yet uninsured rates were lower in expansion compared with non-expansion states. We found few changes in visits. Results suggest that the ACA Medicaid expansion increased health insurance coverage and that while some racial/ethnic disparities were improved, some remained.

Original languageEnglish (US)
Pages (from-to)116-130
Number of pages15
JournalJournal of Health Care for the Poor and Underserved
Issue number1
Publication statusPublished - Feb 1 2019



  • Affordable Care Act
  • Diabetes
  • Health care disparities
  • Health care reform
  • Health policy

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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