The ACA’s Impact On Racial And Ethnic Disparities In Health Insurance Coverage And Access To Care

Buchmueller, Thomas C.; Levy, Helen

doi:10.1377/hlthaff.2019.01394

Cited by 134 publications

(94 citation statements)

References 26 publications

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“… 29 Nonelderly Hispanic adults received the greatest benefit, decreasing the percentage of uninsured individuals by 15%, from 40% to 25%. 30 Specific to middle-aged and older adults, the ACA includes policies to promote free preventive benefits through Medicare and Medicaid, including screenings for cancer, cardiovascular disease, and diabetes. Several of the chronic diseases that showed the worst trends over time in our data were eligible for screening through ACA policies, suggesting that promoting screening alone will be insufficient to reduce disparities.…”

Section: Discussionmentioning

confidence: 99%

Trends in Poor Health Indicators Among Black and Hispanic Middle-aged and Older Adults in the United States, 1999-2018

et al. 2020

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IMPORTANCEAdults who belong to racial/ethnic minority groups are more likely than White adults to receive a diagnosis of chronic disease in the United States. OBJECTIVE To evaluate which health indicators have improved or become worse among Black and Hispanic middle-aged and older adults since the Minority Health and Health Disparities Research and Education Act of 2000. DESIGN, SETTING, AND PARTICIPANTS In this repeated cross-sectional study, a total of 4 856 326 records were extracted from the Behavioral Risk Factor Surveillance System from January 1999 through December 2018 of persons who self-identified as Black (non-Hispanic), Hispanic (non-White), or White and who were 45 years or older. EXPOSUREThe 1999 legislation to reduce racial/ethnic health disparities. MAIN OUTCOMES AND MEASURESPoor health indicators and disparities including major chronic diseases, physical inactivity, uninsured status, and overall poor health. RESULTS Among the 4 856 326 participants (2 958 041 [60.9%] women; mean [SD] age, 60.4 [11.8] years), Black adults showed an overall decrease indicating improvement in uninsured status (β = −0.40%; P < .001) and physical inactivity (β = −0.29%; P < .001), while they showed an overall increase indicating deterioration in hypertension (β = 0.88%; P < .001), diabetes (β = 0.52%; P < .001), asthma (β = 0.25%; P < .001), and stroke (β = 0.15%; P < .001) during the last 20 years.The Black-White gap (ie, the change in β between groups) showed improvement (2 trend lines converging) in uninsured status (−0.20%; P < .001) and physical inactivity (−0.29%; P < .001), while the Black-White gap worsened (2 trend lines diverging) in diabetes (0.14%; P < .001), hypertension (0.15%; P < .001), coronary heart disease (0.07%; P < .001), stroke (0.07%; P < .001), and asthma (0.11%; P < .001). Hispanic adults showed improvement in physical inactivity (β = −0.28%; P = .02) and perceived poor health (β = −0.22%; P = .001), while they showed overall deterioration in hypertension (β = 0.79%; P < .001) and diabetes (β = 0.50%; P < .001). The Hispanic-White gap showed improvement in coronary heart disease (−0.15%; P < .001), stroke (−0.04%; P < .001), kidney disease (−0.06%; P < .001), asthma (−0.06%; P = .02), arthritis (−0.26%; P < .001), depression (−0.23%; P < .001), and physical inactivity (−0.10%; P = .001), while the Hispanic-White gap worsened in diabetes (0.15%; P < .001), hypertension (0.05%; P = .03), and uninsured status (0.09%; P < .001).

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Section: Discussionmentioning

confidence: 99%

Trends in Poor Health Indicators Among Black and Hispanic Middle-aged and Older Adults in the United States, 1999-2018

et al. 2020

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“…In a disease like PC, where there are often multiple therapeutic options from early to advanced stages, lack of shared decision making (due to a lack of trust in the clinician by the patient) and clear understanding of the potential side effects can lead to treatment decisional regret [ 34 ]. Unfortunately, most of the published information available for decision making is based on clinical trials in which Black and Latino men are largely underrepresented [ 35 , 36 ]. Decisions on PC screening, diagnosis, and treatment are thus typically made for the general population based on what we know from research performed in white males, and may omit the important role that trust plays in decision making [ 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Stigma, beliefs and perceptions regarding prostate cancer among Black and Latino men and women

et al. 2021

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Background Health disparities in prostate cancer (PC) are thought to reflect the complex interplay of socioeconomics, environment and biology. The potential impact of beliefs and perceptions about PC among Black and Latino populations on clinical disparities are not well understood. This qualitative study was conducted to assess current prevalent and pervasive stigma, beliefs and perceptions regarding PC among Blacks and Latinos living in a large metropolitan area, thereby identifying potentially modifiable barriers to care. Methods Qualitative data were collected through four separate focus groups of self-identified Black and Latino adult men and women living in Philadelphia to better understand their perceptions of PC diagnosis, screening and treatment. Each focus group was single-sex and conducted by racial/ethnic group in order to assess possible differences in beliefs about PC based on gender and racial/ethnic affiliation. Audio recordings were transcribed verbatim by trained research assistants and qualitative data analysis was conducted using modified grounded theory. Results There were a total of 34 participants: 19 Hispanics/Latinos and 15 Blacks, with equal numbers of men and women (n=17). Median age was 57 years (range: 18 to 85 years). Dominant themes that emerged with respect to PC diagnosis included the stigma surrounding this condition and the perceived role of an “unhealthy lifestyle” and certain sexual behaviors as risk factors for PC development. While the majority of participants acknowledged the importance of PC screening and early detection, discussion centered around the barriers to both the interest in seeking medical care and the likelihood of securing it. These barriers included misunderstanding of PC etiology, distrust of the medical profession, and financial/access limitations. Men expressed substantial confusion about PC screening guidelines. In the Black female group, the role of faith and religion in the course of disease was a major theme. Both Black and Latina females discussed the role of fear and avoidance around PC screening and treatment, as well as the prevalence of misinformation about PC in their familial and social communities. Conclusion Black and Latino focus groups revealed the existence of cultural beliefs, misunderstandings and fears pertaining to PC which could influence health-related behaviors. Some themes were common across groups; others suggested racial and gender predilections. Future targeted efforts focused on directly addressing prevalent misperceptions among underserved communities in urban settings could help to improve health literacy and equity in PC outcomes in these populations.

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“…At the same time, our analysis suggests that health services research, translational medicine, and/or CBPR are types of research that could be further developed within the context of the six health condition areas that were reviewed. Whereas the focus on implementation science and translational research at the NIH has been increasing (92,93), our findings suggest that future research could focus on understudied approaches in Hispanic/Latino health, including, but not limited to, deeper understanding of effectiveness of currently recommended therapies and potential differences among heritage groups (56,(94)(95)(96); participation and/or increased inclusion in genetics/genomic studies (97)(98)(99); innovative strategies to implement recommended guidelines of care, and especially those move beyond the "sideways" approach (100); the intersection (101-103) of social determinants of health other factors on disease risk and the effectiveness of clinical or multi-level interventions (104)(105)(106)(107); design and analysis of multi-level or multi-sectoral (108)(109)(110) interventions; implementation and dissemination studies in real-world settings (92,111); the role of health information technologies on health-care delivery and health outcomes (112)(113)(114)(115)(116)(117)(118); the impact of interventions or policies designed to reduce health and health-care disparities (119)(120)(121)(122)(123)(124)(125)(126); and the effects of national or local policies on healthcare services and health outcomes (e.g., natural experiments) (127,…”

Section: Discussionmentioning

confidence: 99%

Funding of Hispanic/Latino Health-Related Research by the National Institutes of Health: An Analysis of the Portfolio of Research Program Grants on Six Health Topic Areas

Avilés-Santa

Hsu

Lam

et al. 2020

Front. Public Health

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Avilés-Santa et al. NIH Funding Hispanic/Latino Health poses opportunities to evaluate knowledge gained and their clinical application, explore new research questions, or to update some methods or instruments. The findings of the present study suggest opportunities to expand research in understudied mechanisms of disease that could explain differences in prevalence of conditions like diabetes and cancer among different heritage groups. In addition, our findings suggest that the impact of interventions or policies designed to reduce health disparities, innovative multi-level interventions, implementation and dissemination studies, the role of health information technology on health outcomes, and the intersectionality of individual, sociocultural, geographic, and other factors on health outcomes, among others, are understudied approaches, which could potentially advance research in Hispanic/Latino health and contribute to the achievement of better health outcomes in this diverse population.

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The ACA’s Impact On Racial And Ethnic Disparities In Health Insurance Coverage And Access To Care

Cited by 134 publications

References 26 publications

Trends in Poor Health Indicators Among Black and Hispanic Middle-aged and Older Adults in the United States, 1999-2018

Trends in Poor Health Indicators Among Black and Hispanic Middle-aged and Older Adults in the United States, 1999-2018

Stigma, beliefs and perceptions regarding prostate cancer among Black and Latino men and women

Funding of Hispanic/Latino Health-Related Research by the National Institutes of Health: An Analysis of the Portfolio of Research Program Grants on Six Health Topic Areas

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