title: State Medicaid expansion, community interventions, and health care disparities in a United States-Mexico border community.
abstract: OBJECTIVE
  We investigated whether access to and use of health care services increased among residents of a low-income, predominantly Mexican American border community affected by the expansion of Arizona's Medicaid program in 2001 and multiple community-level programs and policies.
  
  
  METHODS
  We used data from a probability sample of 1623 adult residents of Douglas, Arizona, who participated in cross-sectional health surveys in 1998 and 2010. Response rates were 83% and 86%, respectively.
  
  
  RESULTS
  In 2010, participants were more likely to have a usual source of care, to have visited a provider in the previous year, and to have been screened for diabetes and hypertension and less likely to have delayed needed care or to have seen a regular provider in Mexico (P < .001 for all outcomes). Improvements in access to and use of health care were most pronounced among residents with less than a high school education, which reduced or eliminated educational disparities in health care.
  
  
  CONCLUSIONS
  Expansion of public insurance programs can effectively reduce health care disparities when paired with other community-level policies and programs that target medically underserved populations.
authors.affiliation: Brent A. Langellier, Jill Guernsey de Zapien, Maia Ingram, and Scott C. Carvajal are with the Division of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson. Cecilia Rosales is with the Division of Community, Environment and Policy, Mel & Enid Zuckerman College of Public Health.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Langellier
authors.forename: Jill
authors.initials: J
authors.lastname: Guernsey de Zapien
authors.forename: Cecilia
authors.initials: C
authors.lastname: Rosales
authors.forename: Maia
authors.initials: M
authors.lastname: Ingram
authors.forename: Scott C
authors.initials: SC
authors.lastname: Carvajal
mesh_terms: D000328:Adult; D001130:Arizona / Q000453:epidemiology; D003153:Community Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000458:organization & administration*; D017058:Mexican Americans / Q000706:statistics & numerical data; D008875:Middle Aged; D012959:Socioeconomic Factors; D014481:United States