Healthcare Coverage, Access Disparities Remain Even After ACA
A new study revealed that socioeconomic disparities in healthcare and coverage still exists following the ACA.
Source: Thinkstock
By - While the Affordable Care Act has helped to significantly reduce care and access disparities between socioeconomic groups, more work is needed to create true coverage equity, according to a new study from Oregon Health and Sciences University.
Between 2012 and 2015, the rate of uninsured visits to community health centers (CHCs) decreased by 68 percent for white patients, but the rate for Hispanic patients decreased by only half as much.
“After ACA implementation, early studies showed an increase in Medicaid enrollment and a decrease in the numbers of uninsured individuals,” the team said. “Although the ACA was predicted to positively affect health insurance disparities among racial and ethnic minorities, results have been mixed.”
Overall, the rate of Medicaid-insured visits to community health centers (CHCs) increased in Medicaid expansion states by 60 percent for whites, 77 percent for hispanics, and 40 percent for black patients.
Yet the study suggests that “gaps in Medicaid coverage have continued for Hispanic patients, while the disparities have been reduced for non-Hispanic black patients,” the team said. “Nonetheless, previous research found that although members of racial and ethnic populations make up 41 percent of the population, they account for more than 50 percent of those who remain uninsured after expansion.”
The research also revealed that the number of privately insured individuals increased, but that may be because some individuals were ineligible for Medicaid.
The increases in private-insurance were more pronounced in Hispanic groups, and the team suggested that Medicaid access and policy compliance were driving factors for the growth in privately insured individuals.
“Privately insured visits increased for all racial and ethnic groups in non-expansion states, whereas they remained mostly stable in expansion states, the team said. “The sharper increase in privately-covered visits among Hispanic patients may suggest that fewer of these patients were eligible for Medicaid and thus sought private coverage to comply with the individual mandate.
“These results also suggest that health insurance marketplaces were effective in helping some patients find coverage.”
CHCs with a higher ratio of insured to uninsured patients were able to deliver a higher volume of preventative care services and chronic disease screenings, indicating a relationship between insurance equity and health equity.
“Improving their ratio of insured to uninsured patients is especially important, because CHC patient populations tend to be sicker and more complex than non-CHC patients and because CHCs continue to care for more patients,” the team said. “Based on mounting evidence that health insurance plays a role in access to recommended health care, our findings suggest equitable access, even in CHCs, depends on equality in health insurance coverage.”
Based on the analysis, the team believes that the ACA has thus far accomplished many of its goals around addressing coverage disparities, but the issue continues to require attention from policymakers.
“In CHCs, the ACA Medicaid reform contributed to lower uninsured visit rates for all racial and ethnic groups, suggesting that the ACA is having its intended effect on expanding health insurance coverage to more patients,” the team concluded.
“Differences, however, in Medicaid-insured, privately insured, and uninsured visit rates in expansion compared with non-expansion states and among racial and ethnic minority patients remain, indicating equity has not yet been achieved.”
