TY - JOUR
T1 - Racial/ethnic disparities in health insurance and differences in visit type for a population of patients with diabetes after medicaid expansion
AU - Angier, Heather
AU - Ezekiel-Herrera, David
AU - Marino, Miguel
AU - Hoopes, Megan
AU - Jacobs, Elizabeth A.
AU - Devoe, Jennifer E.
AU - Huguet, Nathalie
N1 - Publisher Copyright:
© Meharry Medical College.
PY - 2019/2
Y1 - 2019/2
N2 - This quasi-experimental study evaluated racial/ethnic disparities in health insurance and differences in visits post-versus pre-Affordable Care Act (ACA) Medicaid expansion. We utilized electronic health record data from a population of patients with diabetes aged 19–64 seen in community health centers (CHCs). We used generalized estimating equation Poisson models to estimate incidence rates of insurance type and visits post-(1/1/2014– 12/31/2015) versus pre-(1/1/13–12/31/13) ACA, stratified by racial/ethnic group. We assessed difference-in-differences (DD) and difference-in-difference-in-differences (DDD). The relative disparity in uninsured visits increased between Hispanic and non-Hispanic Whites in expansion states (DD=1.93; 95% CI=1.41, 2.64); the magnitude was greater in expansion compared with non-expansion states (DDD=1.84, 95% CI=1.32, 2.56), yet uninsured rates were lower in expansion compared with non-expansion states. We found few changes in visits. Results suggest that the ACA Medicaid expansion increased health insurance coverage and that while some racial/ethnic disparities were improved, some remained.
AB - This quasi-experimental study evaluated racial/ethnic disparities in health insurance and differences in visits post-versus pre-Affordable Care Act (ACA) Medicaid expansion. We utilized electronic health record data from a population of patients with diabetes aged 19–64 seen in community health centers (CHCs). We used generalized estimating equation Poisson models to estimate incidence rates of insurance type and visits post-(1/1/2014– 12/31/2015) versus pre-(1/1/13–12/31/13) ACA, stratified by racial/ethnic group. We assessed difference-in-differences (DD) and difference-in-difference-in-differences (DDD). The relative disparity in uninsured visits increased between Hispanic and non-Hispanic Whites in expansion states (DD=1.93; 95% CI=1.41, 2.64); the magnitude was greater in expansion compared with non-expansion states (DDD=1.84, 95% CI=1.32, 2.56), yet uninsured rates were lower in expansion compared with non-expansion states. We found few changes in visits. Results suggest that the ACA Medicaid expansion increased health insurance coverage and that while some racial/ethnic disparities were improved, some remained.
KW - Affordable Care Act
KW - Diabetes
KW - Health care disparities
KW - Health care reform
KW - Health policy
UR - http://www.scopus.com/inward/record.url?scp=85062388663&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85062388663&partnerID=8YFLogxK
U2 - 10.1353/hpu.2019.0011
DO - 10.1353/hpu.2019.0011
M3 - Article
C2 - 30827973
AN - SCOPUS:85062388663
SN - 1049-2089
VL - 30
SP - 116
EP - 130
JO - Journal of health care for the poor and underserved
JF - Journal of health care for the poor and underserved
IS - 1
ER -