The Effect of the Affordable Care Act Medicaid Expansion on Disparities in Access to Care and Health Status

2018 ◽  
Vol 77 (5) ◽  
pp. 461-473 ◽  
Author(s):  
Hyunjung Lee ◽  
Frank W. Porell
Keyword(s):  
Health Status ◽  
Health Outcomes ◽  
Access To Care ◽  
Affordable Care Act ◽  
Low Income ◽  
Ethnic Disparities ◽  
Behavioral Risk ◽  
Medicaid Expansion ◽  
The Affordable Care Act ◽  
Racial Ethnic

Before the Affordable Care Act Medicaid expansion, nonelderly childless adults were not generally eligible for Medicaid regardless of their income, and Hispanics had much higher uninsured rates than other racial/ethnic subgroups. We estimated difference-in-differences models on Behavioral Risk Factor Surveillance data (2011-2016) to estimate the impacts of Medicaid expansion on racial/ethnic disparities in insurance coverage, access to care, and health status in this vulnerable subpopulation. Uninsured rates among all poor childless adults declined by roughly 9 percentage points more in states that expanded Medicaid. While expansion also had favorable impacts on most access and health outcomes among Whites in expansion states, there were relatively few such impacts among Blacks and Hispanics. Through 2016, Affordable Care Act Medicaid expansion was more effective in improving access and health outcomes among White low-income childless adults than mitigating racial/ethnic disparities.

The Affordable Care Act Appears to Have Narrowed Racial and Ethnic Disparities in Insurance Coverage and Access to Care Among Young Adults

2017 ◽  
Vol 76 (1) ◽  
pp. 32-55 ◽  
Author(s):  
Brandy J. Lipton ◽  
Sandra L. Decker ◽  
Benjamin D. Sommers
Keyword(s):  
Young Adults ◽  
Access To Care ◽  
Ethnic Groups ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Ethnic Disparities ◽  
Percentage Point Increase ◽  
The Affordable Care Act ◽  
Dependent Coverage ◽  
Racial Ethnic

Prior to the Affordable Care Act, one in three young adults aged 19 to 25 years were uninsured, with substantial racial/ethnic disparities in coverage. We analyzed the separate and cumulative changes in racial/ethnic disparities in coverage and access to care among young adults after implementation of the Affordable Care Act’s 2010 dependent coverage provision and 2014 Medicaid and Marketplace expansions. We find that the dependent coverage provision was associated with similar gains across racial/ethnic groups, but the 2014 expansion was associated with larger gains in coverage among Hispanics and Blacks relative to Whites. After the 2014 expansion, coverage increased by 11.0 and 10.1 percentage points among Hispanics and Blacks, respectively, compared with a 5.6 percentage point increase among Whites. The percentage with a usual source of care and a recent doctor’s visit also increased more for Blacks relative to Whites. Increases in coverage were larger in Medicaid expansion compared with nonexpansion states for most racial/ethnic groups.

Reducing Racial and Ethnic Disparities in Access to Care: Has the Affordable Care Act Made a Difference?

2017 ◽  
Author(s):  
Douglas McCarthy McCarthy ◽  
David C. Radley Radley ◽  
Pamela Riley Riley ◽  
Susan L. Hayes Hayes
Keyword(s):  
Access To Care ◽  
Affordable Care Act ◽  
Ethnic Disparities ◽  
Racial And Ethnic Disparities ◽  
The Affordable Care Act

scholarly journals The Affordable Care Act Medicaid Expansion and Smoking Cessation Among Low-Income Smokers

2019 ◽  
Vol 57 (6) ◽  
pp. e203-e210 ◽  
Author(s):  
J. Travis Donahoe ◽  
Edward C. Norton ◽  
Michael R. Elliott ◽  
Andrea R. Titus ◽  
Lucie Kalousová ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Affordable Care Act ◽  
Low Income ◽  
Medicaid Expansion ◽  
The Affordable Care Act

Changes in Insurance Coverage and Stage at Diagnosis Among Nonelderly Patients With Cancer After the Affordable Care Act

2017 ◽  
Vol 35 (35) ◽  
pp. 3906-3915 ◽  
Author(s):  
Ahmedin Jemal ◽  
Chun Chieh Lin ◽  
Amy J. Davidoff ◽  
Xuesong Han
Keyword(s):  
Affordable Care Act ◽  
Low Income ◽  
Early Stage ◽  
Significant Shift ◽  
Cancer Type ◽  
Medicaid Expansion ◽  
Newly Diagnosed ◽  
Difference In Differences ◽  
Cancer Data ◽  
The Affordable Care Act

Purpose To examine change in the percent uninsured and early-stage diagnosis among nonelderly patients with newly diagnosed cancer after the Affordable Care Act (ACA). Patients and Methods By using the National Cancer Data Base, we estimated absolute change (APC) and relative change in percent uninsured among patients with newly diagnosed cancer age 18 to 64 years between 2011 to the third quarter of 2013 (pre-ACA implementation) and the second to fourth quarter of 2014 (post-ACA) in Medicaid expansion and nonexpansion states by family income level. We also examined demographics-adjusted difference in differences in APC between Medicaid expansion and nonexpansion states. We similarly examined changes in insurance and early-stage diagnosis for the 15 leading cancers in men and women (top 17 cancers total). Results Between the pre-ACA and post-ACA periods, percent uninsured among patients with newly diagnosed cancer decreased in all income categories in both Medicaid expansion and nonexpansion states. However, the decrease was largest in low-income patients who resided in expansion states (9.6% to 3.6%; APC, −6.0%; 95% CI, −6.5% to −5.5%) versus their counterparts who resided in nonexpansion states (14.7% to 13.3%; APC, −1.4%; 95% CI, −2.0% to −0.7%), with an adjusted difference in differences of −3.3 (95% CI, −4.0 to −2.5). By cancer type, the largest decrease in percent uninsured occurred in patients with smoking- or infection-related cancers. A small but statistically significant shift was found toward early-stage diagnosis for colorectal, lung, female breast, and pancreatic cancer and melanoma in patients who resided in expansion states. Conclusion Percent uninsured among nonelderly patients with newly diagnosed cancer declined substantially after the ACA, especially among low-income people who resided in Medicaid expansion states. A trend toward early-stage diagnosis for select cancers in expansion states also was found. These results reinforce the importance of policies directed at providing affordable coverage to low-income, vulnerable populations.

The Potential and Realized Impact of the Affordable Care Act on Health Equity

2020 ◽  
Vol 45 (5) ◽  
pp. 831-845 ◽  
Author(s):  
Paula M. Lantz ◽  
Sara Rosenbaum
Keyword(s):  
Health Care ◽  
Health Outcomes ◽  
Health Equity ◽  
Affordable Care Act ◽  
Health Care Access ◽  
Social Inequalities ◽  
Ethnic Disparities ◽  
Preterm Births ◽  
Social Disparities ◽  
The Affordable Care Act

Abstract The Affordable Care Act (ACA) was designed with multiple goals in mind, including a reduction in social disparities in health care and health status. This was to be accomplished through some novel provisions and a significant infusion of resources into long-standing public programs with an existing track record related to health equity. In this article, we discuss seven ACA provisions with regard to their intended and realized impact on social inequalities in health, focusing primarily on socioeconomic and racial/ethnic disparities. Arriving at its 10th anniversary, there is significant evidence that the ACA has reduced social disparities in key health care outcomes, including insurance coverage, health care access, and the use of primary care. In addition, the ACA has had a significant impact on the volume/range of services offered and the financial security of community health centers, and through section 1557, the ACA broadened the civil rights landscape in which the health care system operates. Less clear is how the ACA has contributed to improved health outcomes and health equity. Extant evidence suggests that the part of the ACA that has had the greatest impact on social disparities in health outcomes—including preterm births and mortality—is the Medicaid expansion.

scholarly journals Changes in Noninsurance and Care Unaffordability Among Cancer Survivors Following the Affordable Care Act

2019 ◽  
Vol 112 (7) ◽  
pp. 688-697 ◽  
Author(s):  
Xuesong Han ◽  
Ahmedin Jemal ◽  
Zhiyuan Zheng ◽  
Ann Goding Sauer ◽  
Stacey Fedewa ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Affordable Care Act ◽  
Sociodemographic Factors ◽  
Behavioral Risk ◽  
Medicaid Expansion ◽  
Female Survivors ◽  
Behavioral Risk Factor Surveillance ◽  
The Affordable Care Act ◽  
Household Incomes ◽  
The Unemployed

Abstract Background Little is known about changes in socioeconomic disparities in noninsurance and care unaffordability among nonelderly cancer survivors following the Affordable Care Act (ACA). Methods Cancer survivors aged 18–64 years nationwide were identified from the Behavioral Risk Factor Surveillance System. Trend and difference-in-differences analyses were conducted to examine changes in percent uninsured and percent reporting care unaffordability pre–(2011 to 2013) and post–(2014 to 2017) ACA Medicaid expansion, by sociodemographic factors. Results A total of 118 631 cancer survivors were identified from Medicaid expansion (n = 72 124) and nonexpansion (n = 46 507) states. Following the ACA, percent uninsured and percent reporting care unaffordability decreased nationwide. Medicaid expansion was associated with a 1.8 (95% confidence interval [CI] = 0.1 to 3.5) percentage points (ppt) net decrease in noninsurance and a 2.9 (95% CI = 0.7 to 5.1) ppt net decrease in care unaffordability. In stratified analyses by sociodemographic factors, substantial decreases were observed in female survivors, those with low or medium household incomes, the unemployed, and survivors with multiple comorbidities. However, we observed slightly increased percentages in reporting noninsurance (ppt = 1.7; 95% CI = −1.2 to 4.5) and care unaffordability (ppt = 3.1, 95% CI = −0.4 to 6.5) in nonexpansion states between 2016 and 2017, translating to 67 163 and 124 160 survivors, respectively. Conclusion We observed reductions in disparities by sociodemographic factors in noninsurance and care unaffordability among nonelderly cancer survivors following the ACA, with largest decreases in women, those with low or medium income, multiple comorbid conditions, the unemployed, and those residing in Medicaid expansion states. However, the uptick of 82 750 uninsured survivors in 2017, mainly from nonexpansion states, is concerning. Ongoing monitoring of the effects of the ACA is warranted, especially in evaluating health outcomes.

Sign in / Sign up

Export Citation Format

Share Document