The major goal of the Affordable Care Act was to expand health insurance coverage. The Department of Health and Human Services will tell you that the Affordable Care Act is working: more Americans are insured. About 16.4 million people gained insurance in the past five years. What do these numbers mean for racial and ethnic minorities who have historically been burdened by barriers to accessing care and higher uninsured rates? New research by Chen and colleagues, in the February 2016 issue of Medical Care, used 2011-2014 National Health Interview Survey data to find out if the ACA significantly reduced racial and ethnic disparities in health care utilization and access. The news is good and bad.
Let’s look at good news first. Observing approximately 90,000 people, researchers found that uninsured rates reduced by 7% for African Americans and Latinos, 5% for other racial and ethnic groups, and 3% for whites in 2014, compared to uninsured rates in 2011. African Americans were more likely to gain insurance coverage through the Health Insurance Marketplace and Medicaid expansion compared to whites. There was also significant increase in the likelihood of having any physician visit. Latinos were 5% and African Americans were 3% more likely to have any physician visit in 2014 compared to 2011. In addition, although there were smaller declines in uninsured rates among Latinos, insured Latinos had a lower probability of delaying or forgoing health care in 2014.
And now the bad news. African Americans, who seem to have benefited the most in terms of gaining insurance, were more likely to delay or skip care in 2014, compared to other racial and ethnic groups. As we all know, skipping and delaying care could land you in the emergency room. Speaking of the emergency room, I have more bad news. For every racial and ethnic group surveyed (African American, Latino, white, and other races) the probability of having any emergency department visit in 2014 was similar to 2011. The ACA has not reduced emergency department utilization.
Emergency department use is often cited as a major reason for increased medical costs. In addition to your traditional hospital emergency department, the boom in free-standing emergency rooms is being observed closely as a potential driver of increased health care costs. Along with increased costs, emergency department use may also signal that life-saving clinical preventative services are not being used.
If you are wondering why the ACA hasn’t reduced emergency department use, a new report, appropriately titled, “Reasons for Emergency Room Use Among US Adults Aged 18-64,” has some answers. The report finds that 77% of the people who visit the emergency room go because of the seriousness of their condition, meaning a doctor told them to go or an ambulance took them to the ER. However, 12% went because their physician’s office wasn’t open, and 7% said they consider the ER to be their main health provider. The report also found that African American adults were more likely to fall into the group that used the ER for less-serious conditions.
What does this mean? To me it says that health insurance does not equal health access or equity. The ACA is working, but there is more work to be done.
Next week, I will be at the Ninth Annual Conference on Health Disparities, listening for solutions. I’ll be sure to report back.
Damika Barr
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