Table 3

Primary Care Visit Rates by Payment Type and Race and Ethnicity: Nonexpansion 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 white35.6133.640.95 (0.84–1.07)1 [Reference]
 Hispanic20.1920.000.99 (0.89–1.10)1.05 (0.92–1.20)
 NH black38.7037.590.97 (0.90–1.05)1.03 (0.91–1.17)
 NH white31.7525.360.80 (0.73–0.87)a1 [Reference]
 Hispanic43.1434.050.79 (0.71–0.87)a0.99 (0.89–1.10)
 NH black31.5725.360.80 (0.69–0.94)a1.01 (0.87–1.17)
Privately insured
 NH white12.7023.351.84 (1.46–2.32)a1 [Reference]
 Hispanic5.5220.053.63 (2.73–4.83)a1.97 (1.43–2.72)b
 NH black11.4320.571.80 (1.40–2.32)a0.98 (0.78–1.23)
  • 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 nonexpansion 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.