Affordable Care Act Medicaid Expansion and Racial and Ethnic Disparities in Access to Primary Care.

The Affordable Care Act's (ACA) Medicaid expansions improved access to care for low-income populations, yet evidence is limited on how these gains differed by race/ethnicity. We examined how Medicaid expansions affected access to primary care, and how race/ethnicity moderated these effects. Using 2011-2016 Behavior Risk Factor Surveillance System data, we found that low-income adults in Medicaid expansion states were 13.9 percentage points more likely to have insurance, 5.6 percentage points more likely to have a usual source of care, and 5.0 percentage points less likely to delay care due to cost post-expansion versus in non-expansion states. Insurance gains were 6.4 percentage points lower for Hispanic adults than White adults in expansion states post-expansion; otherwise, gains were similar by race/ethnicity. Baseline access disparities between White and minority adults persisted post-expansion, especially between White and Hispanic adults. Access may decline comparably for White and minority adults if ACA Medicaid expansions are repealed.