Improving Health in Minority Communities: Evaluating the Medicaid Expansion as an Intervention in Urban Environments

Abstract

The health disparities present the United States have for centuries called into question the quality of the United States healthcare system. A number of scholars assert that the contrastingly poor health of minorities, especially in urban areas, reveals systemic inequality in accessing healthcare services. To investigate the source of poor minority health in urban settings, this paper reviews case studies of prior Medicaid expansions and conducts novel research in the cities of Cleveland, Ohio, and St. Louis, Missouri. By comparing the healthcare access of low-income minorities in these two cities, this analysis identifies key mechanisms by which health coverage leads to increased access and improved health outcomes. The findings of this research point to a clear causal link between health coverage and health access. They furthermore confirm the link between health access and health outcomes. However, the relationship between health coverage, health access, and health outcomes in low-income minority communities is modified by issues of reliable transportation, provider acceptance of Medicaid, and the quality of nearby health systems.