The Affordable Care Act (ACA) helped many low-income people secure health insurance and medical care at most hospitals by enrolling them in Medicaid. But although the ACA’s expansion of Medicaid also provided these individuals with access to specialty medical services, many still sought care at safety net hospitals that don’t provide them instead of going to non–safety net hospitals that do, according to new findings published in JAMA Network Open, reports

Safety net hospitals are U.S. medical centers that are legally obligated to provide health care to everyone regardless of their insurance status or ability to pay.

For the study, researchers at Boston Medical Center reviewed discharge data from 11 states that expanded Medicaid between 2017 and 2021 and six that did not. Researchers wanted to see whether people who had previously sought care at safety net hospitals now opted to visit non–safety net hospitals with more resources. The result? Disparities in the types of patients who used these facilities persisted.

Findings showed that discharges from safety net hospitals were still significantly higher among Black and Latino patients ages 26 to 64, with rates of 38.5% and 39.2%, respectively, compared with 22.6% for white patients. (All individuals lived in higher-poverty ZIP codes in states that expanded Medicaid.)

The data also showed no changes in safety net hospitalizations among uninsured or Medicaid-insured patients whether or not they lived in an expansion state or among subgroups broken down by race, ethnicity or poverty level by ZIP code.

Researchers suggested that the findings might mean some Medicaid patients are satisfied with their care and services at safety net hospitals. But they also stressed that more research is needed to ascertain whether structural racism influences the choices patients make. 

The report is one of the first to assess the effectiveness of major policy changes meant to address health care disparities. So far, Medicaid expansion has been linked to a number of health and economic benefits among all those who are eligible for increased insurance coverage.

In addition, this expanded care has resulted in positive effects on the volume and quality of care available to people, especially those in rural areas. 

To learn more about ongoing disparities in our nation’s health care system, read “These U.S. Cities Have the Most Segregated Hospital Systems.”