Impact of Medicaid Expansion on Insurance Coverage and Cost Barriers to Care : A Difference-in-Differences Analysis Using BRFSS Data

Background The Affordable Care Act (ACA) expanded Medicaid eligibility to improve healthcare access. This study evaluates whether Medicaid expansion led to increased insurance coverage and reduced cost-related barriers to healthcare. Methods We used Behavioral Risk Factor Surveillance System (BRFSS) data from 2012, 2013, 2015, 2016, and 2018. A Difference-in-Differences (DiD) approach was applied, comparing adults in expansion versus non-expansion states before and after 2014. Logistic regression was employed to calculate odds ratios (OR) along with their corresponding 95% confidence intervals (CI). Results Medicaid expansion was associated with 25% greater odds of insurance coverage (OR = 1.25; 95% CI: 1.22, 1.28) and 10% lower odds of cost-related barriers to care (OR = 0.90; 95% CI: 0.89 to 0.91, indicating a statistically significant association (p < 0.001). Conclusion Medicaid expansion under the ACA significantly improved healthcare access by increasing insurance coverage and reducing cost-related barriers.