Medicaid expansion and accessibility to healthcare: The Illinois experience

Abstract

Objective The study examined the impact that the Medicaid expansion in Illinois had upon insurance rates, access to medical care, dental care, pharmaceuticals, and mental‐health counseling between rural and urban counties. Design and Sample A serial cross‐sectional design was used to assess the health perceptions of adults living in Illinois. Measures Survey data were collected in 2012 (n = 6,149) before the Medicaid expansion in Illinois and in 2015 (n = 3,532) after the expansion from rural (n = 4) and urban counties (n = 4). Intervention Medicaid expansion reduced the uninsured rate in both rural (16.39%–4.87%) and urban counties (17.05%–5.2%) and improved self‐reported health. It also increased access to all types of healthcare, with the biggest increase in dental coverage. Results Path analysis indicated that the Medicaid expansion β = −1.03 (p < .01) and poor versus not poor β = −1.50 (p < .01) were a significant predictor to no healthcare access. Rural verses urban location was not significant (β = 0.04); however, race/ethnicity was significantly different (p < .01). Conclusion Findings suggest that although the expansion has increased access to care overall, those who are the most vulnerable are still not benefiting equally from the expansion. Therefore, strategies to assist high‐risk adults in enrolling and using their Medicaid coverage need to developed and implemented.

Disparities in Prenatal Immunization Rates in Rural and Urban US Areas by Indicators of Access to Care

“…Previous work has shown that influenza immunization rates among pregnant women in rural areas of the United States are 6% lower compared to their urban counterparts, 13 with individual or area‐specific challenges in accessing health care like workforce shortages, 14 hospital closures, 15 and having to travel longer distances to receive health care 16,17 as possible reasons for this gap. Insurance status, which is an important predictor of maternal vaccination, 18,19 is also known to vary for urban and rural areas of the United States 20,21 . However, the impact of state policy decisions that influence health access on the urban‐rural disparity in maternal immunization has not been previously investigated.…”

“…Insurance status, which is an important predictor of maternal vaccination, 18,19 is also known to vary for urban and rural areas of the United States. 20,21 However, the impact of state policy decisions that influence health access on the urban-rural disparity in maternal immunization has not been previously investigated. To address this, we aimed to evaluate the disparity in urban-rural immunization rates among pregnant women by indicators of access to health care, and we examined whether this disparity varied by region of the United States.…”