The Effects of Louisiana Medicaid Expansion on Racial and Ethnic Disparities in Insurance Coverage

Background: In the U.S., racial and ethnic minority populations have a higher likelihood of being uninsured than their white counterparts. In Louisiana, minorities account for 41% of the Louisiana population compared to 39% of the national population. Thus, the likelihood of having higher uninsured rates in Louisiana compared to national rates may be greater. In an effort to increase Medicaid coverage among minority populations, Louisiana expanded Medicaid on July 1, 2016. Since then, 471,115 people have gained coverage under this new policy.

Objective: This study aims to document gains in coverage and assess the effects of Medicaid expansion on racial and ethnic disparities in insurance coverage.

Research Design: Data from the American Community Survey (ACS) was used to examine changes in health insurance coverage for nonelderly adults, aged 26 to 64 years old, in the state of Louisiana between 2013 to 2017. Using a difference-in-difference (DID) technique, we compared the differences in the uninsured rate between minority groups (treatment groups) and non-Hispanic whites (control group). Minorities, those who did not report “non-Hispanic white”, were categorized into 3 groups: (1) black, (2) Hispanic, and (3) other. The policy variable for Medicaid expansion was treated as a varying intensity since it took effect in the middle of year (i.e. July 2016). Further, multivariate linear regression models were used to adjust for demographic and socioeconomic factors and standard errors were clustered by survey areas. Lastly, person-weight was used to produce population estimates.

Results: Trends in insurance coverage for the minority groups were analyzed from 2013 to 2017. Specifically, compared with the uninsured rates in 2013, the uninsured rates in 2017 decreased by 7.79, 14.75, 12.22 and 10.41 percentage points for whites, blacks, Hispanics, and other, respectively. In all 5 years, whites continuously had the lowest uninsured rate while Hispanics had the highest uninsured rate. In the DID analysis, the implementation of Medicaid expansion was associated with a significant 9.43% (P<0.001) reduction in the probability of being uninsured. Interaction terms between the expansion indicator and each racial/ethnic group, demonstrate blacks decreased their risk of being uninsured by 5.39 percentage points (P<0.001), a significantly greater improvement compared to the other groups. However, both blacks and Hispanics still had a higher probability of being uninsured than whites at 2.29% (P<0.01) and 10.86% (P<0.001), respectively.

Conclusion: Prior to Louisiana Medicaid expansion, racial/ethnic disparities in insurance coverage were significant. After the implementation of expansion, racial/ethnic disparities in insurance coverage significantly decreased in Louisiana. However, minority groups still have a higher risk of being uninsured. Health professionals and policymakers should continue to monitor the effects and long-term impact of expansion, so that we can then better evaluate the policy’s true direct effects on insurance coverage for minority populations. Lastly, we recommend future researchers to assess across-state variation of the policy to identify more precise changes in racial/ethnic disparities.