Did Health Care Reform Help Kentucky Address Disparities in Coverage and Access to Care among the Poor?

Joseph A. Benitez, E. Kathleen Adams, Eric E. Seiber

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Objective: To evaluate the impact of Kentucky's full rollout of the Affordable Care Act on disparities in access to care due to poverty. Data Source: Restricted version of the Behavioral Risk Factor Surveillance System (BRFSS) for Kentucky and years 2011–2015. Study Design: We use a difference-in-differences framework to compare trends before and after implementation of the Affordable Care Act (ACA) in health insurance coverage, several access measures, and health care utilization for residents in higher versus lower poverty ZIP codes. Principal Findings: Much of the reduction in Kentucky's uninsured rate appears driven by large uptakes in coverage from areas with higher concentrations of poverty. Residents in high-poverty communities experienced larger reductions, 8 percentage points (pp) in uninsured status and 7.5 pp in reporting unmet needs due to costs, than residents of lower poverty areas. These effects helped remove pre-ACA disparities in uninsured rates across these areas. Conclusion: Because we observe positive effects on coverage and reductions in financial barriers to care among those from poorer communities, our findings suggest that expanding Medicaid helps address the health care needs of the impoverished.

Original languageEnglish
Pages (from-to)1387-1406
Number of pages20
JournalHealth Services Research
Issue number3
StatePublished - Jun 2018

Bibliographical note

Publisher Copyright:
© Health Research and Educational Trust


  • Health reform
  • Medicaid expansion
  • access to care
  • disparities

ASJC Scopus subject areas

  • Health Policy


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