Racial/Ethnic Disparities in Access to Care Among Children: How Does Medicaid Do in Closing the Gaps? - Report

The views expressed are those of the authors, and should not be interpreted as being those of the Congressional Budget Office. Acknowledgments Special thanks to Steve Machlin from the Agency for Healthcare Research and Quality for his statistical assistance and helpful comments. Introduction Since the mid-1980s, Medicaid has become an increasingly important source of health coverage for low-income children under age 19 in all racial/ethnic groups. The means-tested program plays an especially large role for children of color because they are more likely to be low-income compared with White children. In 2007, Medicaid and the smaller Children's Health Insurance Program (CHIP) covered nearly 1 of every 5 White children, but roughly 2 of every 5 African American and Hispanic children. 1 Because Medicaid is such a significant source of coverage for children of color, it is important to know whether the program is helping to improve equity in access to care across racial/ethnic groups. Further, as policymakers engaged in health care reform consider the merits of public and private approaches to expanding coverage, an assessment of Medicaid's relative impact on racial/ethnic disparities in access is timely. Most previous research on racial/ethnic disparities in access has focused on adults and has either controlled for health insurance in an analytic model or examined a single insurance group. As a result, we know relatively little about racial/ethnic disparities in health care among children or about how these disparities compare across insurance groups. This brief presents findings from a recent study conducted by the Kaiser Family Foundation to examine how racial/ethnic disparities in access among Medicaid-enrolled children compare with disparities among privately insured and uninsured children. The analysis is based on data for a pooled sample of 15,280 African American, Latino, and White children aged 1-18, from the 2003 and 2004 Medical Expenditure Panel Survey (MEPS). We analyze data on four indicators of access to care-two that examine entry into the health care system and two measures of perceived ability to obtain access. We identify a racial/ethnic difference as a disparity only if statistically significant at p<0.05. Key findings are as follows: • While the vast majority of children fared well on the indicators examined, access problems persist for some children. In 2003-2004, about 8.6% of children lacked a usual source of care (USC), 27.1% had no ambulatory medical visit in the prior year, 9.6% of children with a prior medical visit reported problems …