Date of Award


Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Suzanne Leveille

Second Advisor

Jerry Cromwell

Third Advisor

Laura Hayman


A key focus of the 2010 Patient Protection and Affordable Care Act (ACA) was to improve access to healthcare services in the United States (U.S.) (Stolberg & Pear, 2010). The research purpose was to assess the impact of the ACA’s Medicaid expansion and insurance subsidies on reducing racial/ethnic disparities in coverage, access and the delivery of primary care services, specifically diabetes prevention. Diabetes disproportionately affects minority populations, with inequities reported in the delivery of diabetes care to minorities (Chow, Foster, Gonzalez & McIver, 2012). The Modified Quality Health Outcomes Model was used to guide this research. Statistical analyses were conducted by separately analyzing the 2012-2017 Behavioral Risk Factor Surveillance System (BRFSS) and the 2012 -2015 National Ambulatory Medical Care Survey (NAMCS). Multivariate logistic regression models found that the lowest income groups (<138% FPL) continued to have the lowest levels of insurance post-ACA. In addition, there was an overall 1% gain in having a PCP, with narrowing of racial/ethnic disparities occurring post-ACA. Of interest, whites experienced declines in having a provider, despite gains in insurance. Hispanics continued to have the lowest levels of having a provider post-ACA. High-risk Hispanics were 4 times more likely to be screened than high-risk whites and high-risk adults were 96% more likely to receive diabetes prevention education than the low risk post-ACA. These results lay the groundwork for future research to address policy strategies to improve access to primary care providers and health system strategies to increase consumer awareness of their high-risk for diabetes status.