Authors: Mifta Chowdhury, Amanda Goorin, Dennis Grishin, Aggie Tang


Approximately 1 in 5 adults suffer from a mental illness in the United States and low-income adults represent a particularly vulnerable group. Research indicates that the Affordable Care Act Medicaid expansions led to coverage gains and improvements in access to care for low-income childless adults. However, less research has focused on Medicaid expansion effects by race and other demographic characteristics for individuals with depressive disorders. Using data from the Behavioral Risk Factor Surveillance System (BRFSS) for 2011-2018, we estimated difference-in-differences (DD) models that exploit the quasi-experimental nature of Medicaid expansions implemented on a state-by-state basis. We estimate the effects of Medicaid expansion on measures of health care access and health status and find that Medicaid expansion contributes to a decrease in the uninsured rate and improvements in access to care for low-income individuals living with a depressive disorder. We do not find a differential impact of Medicaid expansion by race, but our research highlights factors that further disadvantage individuals with depressive disorders from obtaining health insurance and accessing care. In general, we find that Medicaid expansion has a greater impact for employed adults, and certain racial subgroups—namely, individuals of color living with a chronic disease and Whites and Blacks without a high school degree—experience a smaller impact from Medicaid expansion on decreasing the uninsured rate and improving health care access.

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