Primary Care Visit Rates by Payment Type and Race and Ethnicity: Expansion States
| Payment Type | Pre-ACA Rate | Post-ACA Rate | Post- vs Pre-ACA Within-Race RR (95% CI) | Post- vs Pre-ACA Between Race DD (95% CI) |
|---|---|---|---|---|
| Medicaid-insured | ||||
| NH white | 34.25 | 54.76 | 1.60 (1.44–1.78)a | 1 [Reference] |
| Hispanic | 21.96 | 38.91 | 1.77 (1.56–2.02)a | 1.11 (0.96–1.28) |
| NH black | 42.95 | 60.26 | 1.40 (1.23–1.61)a | 0.88 (0.75–1.03) |
| Uninsured | ||||
| NH white | 23.95 | 7.73 | 0.32 (0.25–0.42)a | 1 [Reference] |
| Hispanic | 46.61 | 30.54 | 0.66 (0.58–0.74)a | 2.03 (1.53–2.70)b |
| NH black | 28.12 | 11.46 | 0.41 (0.35–0.48)a | 1.26 (0.92–1.73) |
| Privately insured | ||||
| NH white | 19.53 | 18.94 | 0.97 (0.84–1.12) | 1 [Reference] |
| Hispanic | 12.33 | 14.99 | 1.22 (1.05–1.41)a | 1.25 (1.04–1.51)b |
| NH black | 10.31 | 11.70 | 1.14 (0.91–1.42) | 1.17 (0.91–1.51) |
ACA = Patient Protection and Affordable Care Act; DD = difference-in-difference; NH = non-Hispanic; RR = rate ratio.
Note: Generalized estimating equation models were adjusted for facility-level demographic distributions (sex, age, and federal poverty level) and state-level factors (marketplace type, 2014 minimum wage and unemployment rates, and 2013 uninsured rate), clustered by facility to account for within-facility correlation. Visit rates presented per 1,000 patients per month. DD estimates compare change between racial and ethnic groups (reference = NH white) within expansion states before and after ACA Medicaid expansion.
↵a Statistically significant change post- vs pre-ACA RR, P <.05.
↵b Statistically significant DD estimates (reference: pre-ACA, NH white), P <.05.