{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:41:25Z","timestamp":1787013685303,"version":"build-2736575974"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T00:00:00Z","timestamp":1744934400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2025,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n To examine longer\u2010term effects of Medicaid expansion on insurance coverage, access to care, and health, and investigate heterogeneous effects across demographic characteristics of low\u2010income parents.<\/jats:p>\n <\/jats:sec>\n \n Study Setting and Design<\/jats:title>\n We estimated linear probability models for having healthcare coverage and access to care and reporting days of not good physical and mental health in the past 30\u2009days. We adjusted for individual\u2010 and state\u2010level factors, and state and year fixed effects. Our treatment group included low\u2010income parents residing in Medicaid expansion states, and our control group included high\u2010income parents residing in Medicaid expansion states and ineligible for any Affordable Care Act (ACA) subsidies. We used difference\u2010in\u2010differences and event\u2010study designs.<\/jats:p>\n <\/jats:sec>\n \n Data Sources and Analytic Sample<\/jats:title>\n Nationally representative secondary data on self\u2010reported insurance, access, and health status from the core component (2011\u20132019) of the Behavioral Risk Factor Surveillance System (BRFSS) among respondents aged 26\u201354 with at least one child living in the household.<\/jats:p>\n <\/jats:sec>\n \n Principal Findings<\/jats:title>\n \n Medicaid expansion was associated with a 13.4 percentage point (pp) increase in the probability of reporting any health insurance (\n p<\/jats:italic>\n \u2009<\u20090.001), an 11.3\u2009pp decline in the probability of reporting a cost barrier (\n p<\/jats:italic>\n \u2009<\u20090.001), and a 2.4\u2009pp decrease in the probability of reporting days in poor mental health (\n p<\/jats:italic>\n \u2009=\u20090.028) among low\u2010income parents. Our results also suggest parents who were married and those identifying as non\u2010Hispanic white (relative to Hispanic and non\u2010Hispanic other\/multiple race) experienced the largest increases in health insurance coverage.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n While Medicaid expansions improved insurance coverage, access to care, and health status among low\u2010income parents, disparities persisted and, in some cases, widened. These findings have significant implications for policymakers as they consider policies aimed at increasing access to care.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1475-6773.14625","type":"journal-article","created":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T02:13:31Z","timestamp":1745028811000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Examining the Impact of\n ACA<\/scp>\n Medicaid Expansion on Insurance Coverage, Access to Care and Health of Low\u2010Income Parents"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8644-4264","authenticated-orcid":false,"given":"Elena","family":"Andreyeva","sequence":"first","affiliation":[{"name":"Health Policy & Management College Station Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah I.","family":"Rochford","sequence":"additional","affiliation":[{"name":"Health Policy & Management College Station Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1440-3068","authenticated-orcid":false,"given":"Daniel J.","family":"Marthey","sequence":"additional","affiliation":[{"name":"Health Policy & Management College Station Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/pam.21972"},{"key":"e_1_2_10_3_1","unstructured":"CCIIO \u201cEssential Health Benefits Bulletin \u201d2011 https:\/\/www.cms.gov\/CCIIO\/Resources\/Files\/Downloads\/essential_health_benefits_bulletin.pdf."},{"key":"e_1_2_10_4_1","unstructured":"KFF \u201cStatus of State Medicaid Expansion Decisions: Interactive Map \u201d2024KFF accessed August 22 2024 https:\/\/www.kff.org\/affordable\u2010care\u2010act\/issue\u2010brief\/status\u2010of\u2010state\u2010medicaid\u2010expansion\u2010decisions\u2010interactive\u2010map\/."},{"key":"e_1_2_10_5_1","unstructured":"Kaiser Family Foundation \u201cMedicaid Income Eligibility Limits for Parents 2002\u20132024 \u201d2024KFF accessed January 6 2025 https:\/\/www.kff.org\/medicaid\/state\u2010indicator\/medicaid\u2010income\u2010eligibility\u2010limits\u2010for\u2010parents\/."},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001373"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/pam.21961"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1612890"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10754\u2010017\u20109226\u20108"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.8421"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.0290"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m40"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.01394"},{"key":"e_1_2_10_14_1","unstructured":"U.S. Census Bureau \u201cCurrent Population Survey 2024 Annual Social and Economic Supplement \u201d2024 https:\/\/www.census.gov\/library\/stories\/2024\/11\/family\u2010households.html."},{"key":"e_1_2_10_15_1","volume-title":"Parents With Low Incomes Faced Greater Health Challenges and Problems Accessing Adn Affording Needed Health Care in Spring 2021","author":"Haley J. M.","year":"2022"},{"key":"e_1_2_10_16_1","unstructured":"U.Ranji C.Rosenzweig I.Gomez andA.Salganicoff \u201cExecutive Summary: 2017 Kaiser Women's Health Survey\u201d https:\/\/files.kff.org\/attachment\/Executive\u2010Summary\u20102017\u2010Kaiser\u2010Womens\u2010Health\u2010Survey."},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2016.1650"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2017.11.005"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.econedurev.2023.102369"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2021.01394"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/00333549141291S206"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1377\/hpb20200904.405159"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022146510383498"},{"key":"e_1_2_10_24_1","unstructured":"Centers for Disease Control and Prevention (CDC) \u201cThe Behavioral Risk Factor Surveillance System (BRFSS) Overview: BRFSS 2018 \u201d2019 https:\/\/www.cdc.gov\/brfss\/annual_data\/2018\/pdf\/overview\u20102018\u2010508.pdf."},{"key":"e_1_2_10_25_1","volume-title":"Four Methods for Calculating Income as a Percent of the Federal Poverty Guideline (FPG) in the Behavioral Risk Factor Surveillance System (BRFSS)","author":"Hest R.","year":"2019"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.2307\/2137284"},{"issue":"3","key":"e_1_2_10_27_1","first-page":"208","article-title":"A Framework for the Study of Access to Medical Care","volume":"9","author":"Aday L. 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M.Krogstad \u201cWhat We Know About Unauthorized Immigrants Living in the US \u201d2024Pew Research Center accessed January 7 2025 https:\/\/www.pewresearch.org\/short\u2010reads\/2024\/07\/22\/what\u2010we\u2010know\u2010about\u2010unauthorized\u2010immigrants\u2010living\u2010in\u2010the\u2010us\/."}],"container-title":["Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.14625","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T15:58:32Z","timestamp":1758902312000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1475-6773.14625"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,18]]},"references-count":29,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/1475-6773.14625"],"URL":"https:\/\/doi.org\/10.1111\/1475-6773.14625","archive":["Portico"],"relation":{},"ISSN":["0017-9124","1475-6773"],"issn-type":[{"value":"0017-9124","type":"print"},{"value":"1475-6773","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,18]]},"assertion":[{"value":"2024-09-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14625"}}