Table 2

Primary Care Visit Rates by Payment Type and Race and Ethnicity: Expansion States

Payment TypePre-ACA RatePost-ACA RatePost- vs Pre-ACA Within-Race RR (95% CI)Post- vs Pre-ACA Between Race DD (95% CI)
 NH white34.2554.761.60 (1.44–1.78)a1 [Reference]
 Hispanic21.9638.911.77 (1.56–2.02)a1.11 (0.96–1.28)
 NH black42.9560.261.40 (1.23–1.61)a0.88 (0.75–1.03)
 NH white23.957.730.32 (0.25–0.42)a1 [Reference]
 Hispanic46.6130.540.66 (0.58–0.74)a2.03 (1.53–2.70)b
 NH black28.1211.460.41 (0.35–0.48)a1.26 (0.92–1.73)
Privately insured
 NH white19.5318.940.97 (0.84–1.12)1 [Reference]
 Hispanic12.3314.991.22 (1.05–1.41)a1.25 (1.04–1.51)b
 NH black10.3111.701.14 (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.