Barriers to care in an ethnically diverse publicly insured population: is health care reform enough?

Med Care. 2014 Aug;52(8):720-7. doi: 10.1097/MLR.0000000000000172.


Background: The Affordable Care Act provides for the expansion of Medicaid, which may result in as many as 16 million people gaining health insurance coverage. Yet it is unclear to what extent this coverage expansion will meaningfully increase access to health care.

Objective: The objective of the study was to identify barriers that may persist even after individuals are moved to insurance and to explore racial/ethnic variation in problems accessing health care services.

Research design: Data are from a 2008 cross-sectional mixed-mode survey (mail with telephone follow-up in 4 languages), which is unique in measuring a comprehensive set of barriers and in focusing on several select understudied ethnic groups. We examine racial/ethnic variation in cost and coverage, access, and provider-related barriers. The study adhered to a community-based participatory research process.

Subjects: Surveys were obtained from a stratified random sample of adults enrolled in Minnesota Health Care Programs who self-report ethnicity as white, African American, American Indian, Hispanic, Hmong, or Somali (n=1731).

Results: All enrollees reported barriers to getting needed care; enrollees from minority cultural groups (Hmong and American Indian in particular) were more likely to experience problems than whites. Barriers associated with cost and coverage were the most prevalent, with 72% of enrollees reporting 1 or more of these problems. Approximately 63% of enrollees reported 1 or more access barriers. Provider-related barriers were the least prevalent (about 29%) yet revealed the most pervasive disparities.

Conclusions: Many challenges to care persist for publicly insured adults, particularly minority racial and ethnic groups. The ACA expansion of Medicaid, although necessary, is not sufficient for achieving improved and equitable access to care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Community-Based Participatory Research
  • Continental Population Groups / psychology
  • Continental Population Groups / statistics & numerical data*
  • Cultural Competency
  • Ethnic Groups / psychology
  • Ethnic Groups / statistics & numerical data*
  • Female
  • Health Expenditures
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Language
  • Male
  • Medicaid / legislation & jurisprudence
  • Medicaid / statistics & numerical data*
  • Patient Protection and Affordable Care Act / legislation & jurisprudence
  • Patient Protection and Affordable Care Act / statistics & numerical data*
  • Sex Factors
  • Transportation
  • Trust
  • United States
  • Waiting Lists