Objectives: Louisiana extended Medicaid coverage on July 1, 2016, to previously ineligible populations. We aimed to estimate the effect of Louisiana's Medicaid expansion on self-reported affordability of health care.
Methods: We used 2011-2019 data from the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS measured affordability of health care by asking respondents 2 questions: (1) whether they could not see a doctor due to cost in the previous 12 months and (2) whether they could not get a prescribed medication due to cost in the previous 12 months. We estimated difference-in-differences and difference-in-difference-in-differences analytical models using multivariable linear regression that compared trends in Louisiana with trends in states that did not expand Medicaid during the study period.
Results: Compared with adults aged <65 with annual household income >138% of the federal poverty level (FPL) in nonexpansion states, Medicaid expansion in Louisiana decreased the percentage of adults aged <65 with annual household income ≤138% FPL who reported being unable to see a doctor due to cost by 5.1 percentage points (95% CI, -6.5 to -3.6; P < .001) and unable to afford prescribed medication by 7.9 percentage points (95% CI, -9.2 to -6.6; P < .001). We found similar estimates when we limited the comparison group to Southern nonexpansion states.
Conclusions: Louisiana's Medicaid expansion lowered cost barriers to health care. Further research may find improvements in health care affordability in states that have not yet expanded Medicaid.
Keywords: Medicaid expansion; affordability; health care; health policy; policy evaluation.