PEDIATRICS Vol. 108 No. 5 November 2001, pp. 1135-1142
Differential Impact of Recent Medicaid Expansions by Race and Ethnicity
Received Dec 18, 2000; accepted Mar 26, 2001.
,
, ,, , and
From the * Albert Einstein College of Medicine, Children's
Hospital at Montefiore, Bronx, New York; Objective. Between 1989 and 1995, expansions in Medicaid eligibility provided publicly financed health
insurance to an additional 7 million poor and near-poor children. It is
not known whether these expansions affected children's insurance
coverage, use of health care services, or health status differently,
depending on their race/ethnicity. The objective of this study was to
examine, by race/ethnicity, the impact of the recent Medicaid
expansions 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 Health Interview Surveys of 1989 and 1995, we compared
changes in measures of health insurance coverage, health services
utilization, and health status for poor white, black, and Hispanic 1- to 12-year-old children. To control for underlying trends over time, we
subtracted 1989 to 1995 changes in these outcomes among nonpoor
children from changes among the poor children for each race/ethnicity
group. Measures of coverage included uninsured rates and Medicaid
rates. Utilization measures included annual probability of visiting a doctor, annual number of doctor visits, and annual probability of
hospitalization. Health status measures included self-reported health
status and number of restricted-activity days in the 2 weeks before the
interview. Differences in means were analyzed with the use of
Student's t tests accounting for the clustering sample
design of the National Health Interview Surveys.
Results. Among poor children between 1989 and 1995, uninsured rates declined by 4 percentage points for whites, 11 percentage points for blacks, and 19 percentage points for Hispanics.
Medicaid rates for these groups increased 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 children in
good, fair, or poor health. Among those in excellent or very good
health, the respective increases were 1 percentage point for poor
whites (not significant), 7 percentage points for poor blacks, and 3 percentage points for poor Hispanics (not significant). Significant
increases in numbers of doctor visits per year were recorded only for
poor Hispanics who were in excellent or very good health, whereas
significant decreases in hospitalizations were recorded for Hispanics
who were in good fair or poor health. Measures of health status
remained unchanged for poor children over time. The recorded decreases
in uninsured rates and increases in Medicaid coverage remained robust
to adjustments for underlying trends for all 3 race/ethnicity groups.
With respect to adjusted measures of utilization and health status, the
only significant differences found were among poor blacks who were in
good, fair, or poor health and who registered increases in the
likelihood of hospitalization and in poor Hispanics who were in
excellent or very good health and who registered decreases in the
numbers of restricted-activity days.
Conclusions. Recent expansions in the Medicaid program
from 1989 to 1995 produced greater reductions in uninsured rates among
poor minority children than among poor white children. Regardless of
race/ethnicity, poor children did not seem to experience significant
changes during the period of the expansions in either their level of
health service utilization or their health status.Medicaid, health insurance, health status, health services.
Baruch College, New York,
New York; § City University of New York, New York, New York; and
National Bureau of Economic Research, New York, New York.
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