Primary Care Visit Rates by Payment Type and Race and Ethnicity: Nonexpansion 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 | 35.61 | 33.64 | 0.95 (0.84–1.07) | 1 [Reference] |
| Hispanic | 20.19 | 20.00 | 0.99 (0.89–1.10) | 1.05 (0.92–1.20) |
| NH black | 38.70 | 37.59 | 0.97 (0.90–1.05) | 1.03 (0.91–1.17) |
| Uninsured | ||||
| NH white | 31.75 | 25.36 | 0.80 (0.73–0.87)a | 1 [Reference] |
| Hispanic | 43.14 | 34.05 | 0.79 (0.71–0.87)a | 0.99 (0.89–1.10) |
| NH black | 31.57 | 25.36 | 0.80 (0.69–0.94)a | 1.01 (0.87–1.17) |
| Privately insured | ||||
| NH white | 12.70 | 23.35 | 1.84 (1.46–2.32)a | 1 [Reference] |
| Hispanic | 5.52 | 20.05 | 3.63 (2.73–4.83)a | 1.97 (1.43–2.72)b |
| NH black | 11.43 | 20.57 | 1.80 (1.40–2.32)a | 0.98 (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.