The Affordable Care Act Reduced Socioeconomic Disparities In Health Care Access

Griffith, Kevin N.; Evans, Leigh; Bor, Jacob

doi:10.1377/hlthaff.2017.0083

Cited by 121 publications

(115 citation statements)

References 33 publications

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“…[18][19][20][21][22][23] We describe the specific association of these variables with the use of surgery for NSCLC. County-level uninsured rate is known to have strong association with demographic and area-level socioeconomic factors, 17,24 and corrective measures mitigating adverse consequences of area-level socioeconomic factors can improve access to health services and outcomes. 22,25 For example, federal, state, and county policy initiatives such as Medicaid eligibility expansions, health-care safety nets, and public health programs targeting rural communities may enhance financial well-being, insurance coverage, and access to health care at the county level.…”

Section: Discussionmentioning

confidence: 99%

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

Sineshaw

Sahar

Osarogiagbon

et al. 2020

Chest

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BACKGROUND: Although counties are the smallest geographic level for comprehensive healthcare delivery analysis, little is known about county-level variations in receipt of curativeintent surgery for early-stage non-small cell lung cancer (NSCLC) and factors contributing to such variations in the United States.METHODS: A total of 179,189 patients aged $ 35 years who were diagnosed with stage I to II NSCLC between 2007 and 2014 in 2,263 counties were identified from 39 states, the District of Columbia, and Detroit population-based cancer registries; the data were compiled by the North American Association of Central Cancer Registries. The percentage of patients who underwent surgery was calculated for each county with $ 20 cases. Adjusted risk ratios were generated by using generalized estimating equation models with modified Poisson regression.RESULTS: Receipt of surgery for early-stage NSCLC during 2007 to 2014 according to county ranged from 12.8% to 48.6% in the lowest decile of counties, to 74.3% to 91.7% in the highest decile of counties. There were pockets of low surgery receipt rate counties within each state. For example, there was a 25% absolute difference between the lowest and highest surgery receipt rate counties in Massachusetts. Counties in the lowest quartile for receipt of surgery were those with a high proportion of non-Hispanic black subjects, high poverty and uninsured rates, low surgeon-to-population ratio, and nonmetropolitan status.CONCLUSIONS: Receipt of curative-intent surgery for early-stage NSCLC varied substantially across counties in the United States, with pockets of low receipt counties in each state. Low surgery receipt counties were characterized by unfavorable area-level socioeconomic and health-care delivery factors. CHEST 2020; 157(1):212-222

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Section: Discussionmentioning

confidence: 99%

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

Sineshaw

Sahar

Osarogiagbon

et al. 2020

Chest

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“…Since the ACA was enacted, studies have demonstrated that insurance coverage and health care access and utilization have improved across the country, particularly among groups that have historically had low levels of coverage, such as low-income individuals. 10 - 16 What is not well established, however, is how financial strain and vulnerability have improved as a result of the ACA’s increase in access, specifically with regard to different FPL groups. Other insurance expansion programs, such as the Massachusetts Health Reform and Oregon Health Insurance Experiment, have been shown that insurance reduced health-related financial stress.…”

Section: Introductionmentioning

confidence: 99%

The Affordable Care Act Attenuates Financial Strain According to Poverty Level

McKenna

Langellier

Alcalá

et al. 2018

INQUIRY

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We use data from the 2011-2016 National Health Interview Survey to examine how the Patient Protection and Affordable Care Act (ACA) has influenced disparities in health care–related financial strain, access to care, and utilization of services by categories of the Federal Poverty Level (FPL). We use multivariable regression analyses to determine the ACA’s effects on these outcome measures, as well as to determine how changes in these measures varied across different FPL levels. We find that the national implementation of the ACA’s insurance expansion provisions in 2014 was associated with improvements in health care–related financial strain, access, and utilization. Relative to adults earning more than 400% of the FPL, the largest effects were observed among those earning between 0% to 124% and 125% to 199% of the FPL after the implementation of the ACA. Both groups experienced reductions in disparities in financial strain and uninsurance relative to the highest FPL group. Overall, the ACA has attenuated health care–related financial strain and improved access to and the utilization of health services for low- and middle-income adults who have traditionally not met income eligibility requirements for public insurance programs. Policy changes that would replace the ACA with less generous age-based tax subsidies and reductions in Medicaid funding could reverse these gains.

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“…The ACA is the largest scaled coverage and benefit expansion in the USA in recent years. The reform specifically targeted low‐ and moderate‐income adults, and has led to successful expansions of insurance coverage and improvements in healthcare access . Several major ACA provisions were also designed to address OOP affordability of health care.…”

Section: Discussionmentioning

confidence: 99%

Disparities in cost‐related drug nonadherence under the Affordable Care Act

Shooshtari

Jung

2019

J Pharm Health Serv Res

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Objective The Affordable Care Act (ACA), implemented in 2014 in the USA, featured several policies relevant to patients’ out‐of‐pocket spending for prescription drugs. Our study examined how disparities in cost‐related nonadherence (CRN) to prescription drugs changed by race, ethnicity and socioeconomic status after the ACA. Methods We analysed a nationally representative sample of nonelderly adults aged 18–64 in the 2013–2017 National Health Interview Survey data. The first outcome measure captured individuals who could not afford needed prescription drugs in the past 12 months. Among participants who filled a prescription in the past year, three outcome measures included skipped medication doses, taking less medicine or delaying filling a prescription to save money during that time. Interactions between income, education, and race and ethnicity variables with the post‐ACA indicator capture how the ACA affected socioeconomic and racial disparities in CRN, while linear probability regression models adjusted for patient characteristics, region indicators and year dummies. Key finding Income‐based disparities in CRNs narrowed after the ACA. Individuals with incomes below 138% federal poverty level (FPL) had larger reductions in the probability of being unable to afford prescription drugs (−3.83% points), skipping doses (−3.33% points), taking less medication (−3.17% points) or delaying medication fills to save money (−3.68% points) than those with income greater than 400% FPL. Several CRN measures declined more among Hispanics than among non‐Hispanic white people. The ACA was also associated with greater CRN reductions among individuals with a high school education. Conclusion The narrowed disparities in CRN suggest the ACA effectively improved prescription drug adherence by those vulnerable to healthcare cost burdens.

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The Affordable Care Act Reduced Socioeconomic Disparities In Health Care Access

Cited by 121 publications

References 33 publications

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

The Affordable Care Act Attenuates Financial Strain According to Poverty Level

Disparities in cost‐related drug nonadherence under the Affordable Care Act

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