Department or Program


Primary Wellesley Thesis Advisor

Kyung H. Park


The United States healthcare system is unlike any other in the developed world. The United States pays more for healthcare, has poorer health outcomes, and the highest uninsured rate of the developed world as well as rampant health inequities across race, gender, and class. In an attempt to remedy several of these issues and provide health insurance to low-income Americans, the Patient Protection and Affordable Care Act (ACA) was passed in 2010. As a part of the ACA, Medicaid was expanded to cover individuals living below 138% of the federal poverty line. Given that the Supreme Court determined that states should have the choice to expand Medicaid, only 25 states expanded Medicaid by January 2014. Using comprehensive health data from the Behavioral Risk Factor Surveillance System, this study explores whether the ACA, and particularly, the expansion of Medicaid, reduced racial and ethnic disparities in health insurance, access, utilization, and outcomes. By employing a difference-in-difference strategy, we find that racial disparities in health insurance coverage, financial risk from healthcare costs, and self-reported general health and mental health decrease. However, there are ambiguous effects on health utilization and physical health outcomes. These improvements are not uniform across race: blacks experience far greater improvements than Hispanics, relative to non-Hispanic whites. Additionally, there are no remarkable differences in racial and ethnic disparities in health between expansion and non-expansion states and individuals living below and above 138% of the federal poverty line after the full implementation of the ACA.