摘要：We compared the race and ethnicity of individuals residing in states that did and did not expand Medicaid in 2014. Findings indicated that African Americans and Native Americans with substance use disorders who met new federal eligibility criteria for Medicaid were less likely than those of other racial and ethnic groups to live in states that expanded Medicaid. These findings suggest that the uneven expansion of Medicaid may exacerbate racial and ethnic disparities in insurance coverage for substance use disorder treatment. The Patient Protection and Affordable Care Act’s 1 Medicaid expansion has the potential to connect many Americans in need of substance use disorder (SUD) treatment with insurance coverage. However, some racial and ethnic groups may be underrepresented in the Medicaid expansion population because they are more likely to live in states that have not expanded Medicaid. 2,3 Although racial and ethnic minority groups constitute 37% of the US population, they constitute 47% of individuals who meet new federal eligibility criteria for Medicaid. 2 The estimated percentage of individuals who meet the new Medicaid criteria and live in an expansion state is 34% among African Americans, 45% among Whites, 53% among Latinos, and 69% among Asians. Yet, how Medicaid expansion may affect long-standing racial and ethnic disparities in insurance coverage for SUD treatment remains unknown. 2 Recent estimates have shown a decrease in the number of nonelderly adults who were uninsured, from 18.4% in 2013 to 15.7% during the first 3 months of 2014. 4 However, little change occurred in the rate of the uninsured in nonexpansion states. 4 Among expansion states, the most significant reduction in the rate of uninsured people was among working-age Latinos. 5 Existing estimates do not include all major racial and ethnic groups and are not specific to individuals with SUDs. To address this gap, we estimated the proportion of people with SUDs residing in Medicaid expansion and nonexpansion states by race and ethnicity.
