Racial and Ethnic Disparities in Health Care Access and Utilization Under the Affordable Care Act

Abstract

Objective:To examine racial and ethnic disparities in health care access and utilization after the Affordable Care Act (ACA) health insurance mandate was fully implemented in 2014.Research Design:Using the 2011–2014 National Health Interview Survey, we examine changes in health care access and utilization for the nonelderly US adult population. Multivariate linear probability models are estimated to adjust for demographic and sociodemographic factors.Results:The implementation of the ACA (year indicator 2014) is associated with significant reductions in the probabilities of being uninsured (coef=−0.03, P<0.001), delaying any necessary care (coef=−0.03, P<0.001), forgoing any necessary care (coef=−0.02, P<0.001), and a significant increase in the probability of having any physician visits (coef=0.02, P<0.001), compared with the reference year 2011. Interaction terms between the 2014 year indicator and race/ethnicity demonstrate that uninsured rates decreased more substantially among non-Latino African Americans (African Americans) (coef=−0.04, P<0.001) and Latinos (coef=−0.03, P<0.001) compared with non-Latino whites (whites). Latinos were less likely than whites to delay (coef=−0.02, P<0.001) or forgo (coef=−0.02, P<0.001) any necessary care and were more likely to have physician visits (coef=0.03, P<0.005) in 2014. The association between year indicator of 2014 and the probability of having any emergency department visits is not significant.Conclusions:Health care access and insurance coverage are major factors that contributed to racial and ethnic disparities before the ACA implementation. Our results demonstrate that racial and ethnic disparities in access have been reduced significantly during the initial years of the ACA implementation that expanded access and mandated that individuals obtain health insurance.

Impact of the Affordable Care Act on Health Care Access and Utilization Among Latinos

“…Several variables were included in analyses as potential confounders based on the literature 6 Logistic regression models were estimated for each of the 5 outcomes to determine whether year, Latino heritage group, citizenship status, and language of survey administration were associated with odds of the outcomes. These models included all aforementioned controls along with survey year, Latino heritage group, citizenship status, and language of survey administration ( Table 2).…”

“…6,35,36 Access indicators included dichotomous measures of (1) health insurance status (currently insured); (2) delaying necessary medical care, excluding dental care, because of costs in the past 12 months; and (3) forgoing necessary medical care, excluding dental care, because of costs in the past 12 months. Utilization indicators included dichotomous measures of (1) having had at least 1 ED visit in the past 12 months, even if this visit resulted in admission to the hospital; and (2) having had a physician (in general practice, family medicine, or internal medicine) visit in the past 12 months.…”

A Latino Patient-Centered, Evidence-Based Approach to Diabetes Prevention

“…7 Primary care is an ideal setting for implementing behavioral lifestyle interventions for all patients, including Latinos. Latinos increasingly have access to primary care 23 , and primary care leverages the weight of providers' recommendations, provides opportunities for ongoing support for maintaining behavior change, and can be integrated with management of comorbid conditions. Given increasing policy support for providing DPP-based interventions in primary care, culturally adapting these programs is critical for addressing disparities in obesity and obesity-related chronic conditions including diabetes.…”

“…20,21 Furthermore, no DPP translation studies, especially technology-supported DPP, with this priority population have been conducted in primary care, leaving a critical evidence gap for Latinos. 7,22 Latinos have increasing access to primary care 23 , which can be an effective context to promote sustainable chronic disease prevention. Thus, cultural adaptation of evidence-based technologysupported DPP translations is needed to effectively address obesity and its related clinical sequelae among Latinos in primary care.…”

Changes in Health Insurance Coverage Associated With the Affordable Care Act Among Adults With and Without a Cancer History

“…14,15 The decrease was evident in all states and sociodemographic groups though more pronounced for adults in states that expanded Medicaid, 16,17 in persons with low socioeconomic status, and in racial and ethnic minorities. 18,19 The decline in uninsured rates nationally comes from a 5.5 percentage point increase in private coverage, and a 2.2 percentage point increase in public (Medicaid) enrollment. 20 …”