Heterogeneous effects of Medicaid expansion on food security measures

The 2014 Affordable Care Act (ACA) included state-level Medicaid expansion programs, which have been credited with gains in food security for low-income, able-bodied, childless adults without dependents (ABAWDs). Yet, ABAWDs represent a diverse cohort who experience disparities along racial and ethnic lines, which could be partly responsible for differences in health-related outcomes. This study uses data from the Current Population Survey Food Security Supplement to estimate the heterogeneous effect of ACA Medicaid expansion on food security among ABAWDs by race, ethnicity, and income. We find that Medicaid expansion improved food security for households headed by White ABAWDs-particularly those with incomes above 50% of the federal poverty line-but we do not find similarly significant evidence of gains among some historically marginalized populations. We find weak evidence that suggests that households headed by Hispanic ABAWDs may have experienced gains. However, Black-headed ABAWD households had significantly worse food insecurity relative to the pooled sample of all races and ethnicities. Our results suggest that the relationship between healthcare access and food security is complex and, although spillover effects from a change in healthcare policy can influence food security status, such effects may not be equitably distributed across race, ethnicity, or income.