Introduction
This study aims to evaluate the trends in the impact of Medicaid expansion on the
use of selected recommended clinical preventive services and examine the differences
in use by income level over time.
Methods
The data were obtained from the 2011–2019 Behavioral Risk Factor Surveillance System
and were analyzed in 2021. This study conducted a difference-in-differences analysis
of the association between Medicaid expansion and the use of 5 clinical preventive
services, including colon/breast/cervical cancer screenings, HIV testing, and influenza
vaccination. Annual percentage change was applied to assess the trends in the impact
of Medicaid expansion on the use of clinical preventive services.
Results
The use of all the 5 clinical preventive services varied over time. In almost every
year, the use of 4 clinical preventive services (all but HIV testing) among Medicaid
expansion states was higher than that among the nonexpansion states. People with lower
income used 4 clinical preventive services (all but HIV testing) less frequently than
those with higher income, regardless of their residence in expansion or nonexpansion
groups. Among the lower-income group, the use of 5 clinical preventive services increased
after Medicaid expansion almost every year, with the use of colon cancer screening
and HIV testing reaching statistical significance and the impact of Medicaid expansion
in the use of each clinical preventive service kept stable from 2014 to 2019.
Conclusions
These findings provide evidence that Medicaid expansion may be associated with sustainably
increased use of the selected recommended clinical preventive services among the lower-income
population and that Medicaid expansion to reduce financial barriers may be an effective
strategy to improve population health.
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Article Info
Publication History
Published online: December 24, 2021
Identification
Copyright
Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
