Abstract
Latinos in the USA are the least likely to have health insurance compared to other racial and ethnic groups. Mexican Americans, the largest subgroup of US Latinos, have particularly great barriers to health care access and experience disparities in care and in health outcomes. The Affordable Care Act (ACA), enacted in 2010 and mostly implemented by January 1, 2014, was designed in part to improve health insurance access for uninsured groups, including an option for states to expand Medicaid. We assess the ACA’s effect on six health-related outcomes for Mexican American adults (18–64 years of age). We estimate difference-in-difference models using the IPUMS National Health Interview Survey data; Mexican Americans living in the West are assigned as the treatment group (where ~ 97% of Mexican Americans live in states which expanded Medicaid) and the South as a control group (where ~ 4% of Mexican Americans live in states which expanded Medicaid). We designate 2010–2013 as the pre-treatment period and 2014–2018 as the post-treatment period. The results for the full sample suggest that Medicaid expansion increased Mexican Americans’ probability of having health insurance, a physician visit in the past year, and self-reported diabetes, chronic kidney disease, and hypertension; and decreased the probability of reporting self-assessed health of “very good” or “excellent.” Heterogeneity analyses suggest remarkably large gains for those who are men, foreign-born, undocumented, with less than high school levels of education, with incomes less than 100% of the federal poverty line (FPL), and those who have lived more than 5 and less than 10 years in the USA.
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Notes
There is no consensus about terminology to identify the group of people living in the USA with Spanish and Latin American heritage. In most government surveys, the terms Latino and Hispanic are both included. However, in more nuanced explorations of nomenclature, these terms reflect slightly different subpopulations. Additionally, many people in the USA prefer other terms including Chicano, Tejano, and references to specific countries of origin. In this paper, when referring to the larger group of people in the USA with Spanish and Latin American heritage, we use Latino as it was the term used most often in the literature. We use specific terminology to refer to research on those subpopulations, such as Mexican American, to describe people with Mexican heritage (both US born and foreign born).
NHIS collects information on total office visits to health professionals in past 12 months. We create the binary variable, physician visit in past year, following the previous literature by (Chen et al. 2016).
In 2018, 25% of the all-U.S. immigrants are born in Mexico (Budiman 2020).
Although all six outcome variables are binary, we estimate the linear probability model for our baseline regressions because it delivers well-grounded average treatment effects (Angrist and Pischke 2008). However, we also consider the logistic regressions for robustness checks.
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Naher, S., Amoah, D., Cartwright, K. et al. Impacts of the Affordable Care Act Medicaid Expansion on Health Insurance, Health Care Utilization, and Health Outcomes for Mexican Americans. J Econ Race Policy 6, 34–52 (2023). https://doi.org/10.1007/s41996-022-00100-0
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DOI: https://doi.org/10.1007/s41996-022-00100-0