Examining trends in health care access measures among low-income adult smokers in Ohio: 2012–2019

•Changes to access to care measures among low-income smokers following Medicaid expansion have not been characterized.•Health care access measures among smokers related to affordability of care and unmet needs improved following Medicaid expansion in Ohio.•The was no change in having a usual source of care, an important indicator of preventive care use.•A comprehensive improvement on access to care is essential for tobacco cessation efforts, early management of health problems, and reduction in smoking-related health care costs and disparities. Smokers are more likely to be low-income with limited access to health services. Although Medicaid expansion under the Patient Protection and Affordable Care Act improved access to care for low-income adults, long-term trends in health care access among low-income smokers remain uncharacterized. The study evaluated changes in five access measures among low-income nonelderly (19–64) adults (N = 28976) across smoking status using pooled data from a statewide survey in Ohio covering pre- (i.e., 2012) and post-Medicaid expansion periods (2015, 2017, and 2019) guided by a comprehensive framework of health care access. We found improvements in some, but not all, health care access measures among low-income smokers in the post-Medicaid-expansion period compared to the pre-expansion period. Compared to 2012, the odds for unmet dental care needs declined in 2015 (aOR = 0.67, 95 % CI = 0.45–1.01), 2017 (aOR = 0.53, 95 % CI = 0.35–0.81), and 2019 (aOR = 0.65, 95 % CI = 0.40–1.05) (p trend