Health status, health care access and utilization among low-income adults potentially eligible for Medicaid expansion in Texas

Texas is one of states not expanding Medicaid, yet it has a large uninsured population and the most restrictive Medicaid eligibility levels for populations other than children and pregnant women in the country. Adults aged between 19 and 64 years in the income range for ACA\u27s Medicaid expansion are potentially eligible for coverage if Texas expands Medicaid or adopts a Texas alternative that expands health care coverage. Understanding their health status and health care need will provide insights into the potential impacts of state\u27s decision on the ACA Medicaid expansion. Objectives are 1. To determine the differences in the health status, health care access and health care utilization of non-elderly adults with incomes between 0-138% of the federal poverty level in Texas based on their insurance status 2. To determine the differences in the health status, health care access and health care utilization of non-elderly adults with incomes between 138-400% of the federal poverty level in Texas based on their insurance status 3. To determine if the differences between the insured and uninsured in the group with incomes between 0-138% of the federal poverty level exceed those of the group with incomes between 138-400% of the federal poverty level. A cross sectional comparative analysis was done using Texas Behavioral Risk Factor Surveillance System (BRFSS) 2012-2013 data. The study population was nonelderly adults between 19 and 64 years of age and having family income at or below 400% of the federal poverty level in Texas. Health status, health care access and utilization were assessed by analyzing relevant survey questions. We described respondent characteristics using frequency analyses to examine the bivariate relationships between independent and dependent variables. Multivariate logistic regressions were performed and odds ratios were reported to assess the independent effect of health insurance status in two income ranges on the dependent variables after controlling for the confounding effects of the covariates. Potential confounders are socio-demographic characteristics, including gender, age, race/ethnicity, marital status, education attainment, employment, and place of residence. The 95% confidence intervals and p-values were reported and all statistical significance was assessed at p\u3c0.05 using 2-sided tests. The study found that among low income, non-elderly adults who are potentially eligible for Medicaid if Texas expands coverage are more likely to be young, Hispanic, less educated, and in the labor force. The uninsured were healthier and had less health care access and utilization than the insured in the same income ranges. However, the magnitudes of insurance effect on health status, health care access and utilization were different between the low income and higher income groups. The insurance effect on health status was greater in the low income group while that on health care access and utilization was smaller in the low income group than in the higher income group