The Affordable Care Act (ACA) sought to provide universal health insurance coverage for Americans through a combination of Medicaid expansions, insurance market policies, advance premium tax credits, among other reforms. Lawmakers intended to enforce Medicaid expansion through the ACA at the federal level. However, the June 2012 United States (U.S.) Supreme Court decision in National Federation of Independent Business v. Sebelius allowed states to opt-out of Medicaid expansion. As a result, states took different approaches to expand Medicaid eligibility. This study uses data from the Inter-university Consortium for Political and Social Research (ICPSR) to analyze how opting in or out of Medicaid expansion has affected the likelihood of accessing primary healthcare in expansion states relative to non-expansion states. Using logistic regression methods, this study analyzed the changes in the patterns of clinic appointments among Medicaid patients in six states – Georgia, Illinois, Montana, New Jersey, Pennsylvania, and Texas before and after the major ACA insurance expansions. As a secondary contribution, this paper addresses concerns about the adequacy of primary health care to meet the increased demand for healthcare after the expansion of Medicaid insurance. The impact of Medicaid expansion on the likelihood of accessing primary healthcare is not statistically significant. However, during the second year following Medicaid expansion in Illinois, New Jersey, and Oregon, average appointment wait times for Medicaid patients increased. In the post-Medicaid expansion period, a significant amount of appointments could be scheduled with mid-level providers which suggest issues in the availability of primary healthcare for Medicaid patients.


Scott Granberg-Rademacker

Committee Member

Kevin Parsneau

Committee Member

Russell Fricano

Date of Degree




Document Type



Master of Public Administration (MPA)


Social and Behavioral Sciences



Rights Statement

In Copyright