Urban Institute, Health Policy Center, Washington, D.C., USA.
Health Aff (Millwood). 2012 May;31(5):920-30. doi: 10.1377/hlthaff.2011.1086.
There are large differences in US health insurance coverage by racial and ethnic groups, yet there have been no estimates to date on how implementation of the Affordable Care Act will affect the distribution of coverage by race and ethnicity. We used a microsimulation model to show that racial and ethnic differentials in coverage could be greatly reduced, potentially cutting the eight-percentage-point black-white differential in uninsurance rates by more than half and the nineteen-percentage-point Hispanic-white differential by just under one-quarter. However, blacks and Hispanics are still projected to remain more likely to be uninsured than whites. Achieving low uninsurance under the Affordable Care Act will depend on effective state policies to attain high enrollment in Medicaid and the Children's Health Insurance Program and the new insurance exchanges. Coverage gains among Hispanics will probably depend on adoption of strategies that address language and related barriers to enrollment and retention in California and Texas, where almost half of Hispanics live. If uninsurance is reduced to the extent projected in this analysis, sizable reductions in long-standing racial and ethnic differentials in access to health care and health status are likely to follow.
美国的医疗保险覆盖情况在不同种族和族裔群体之间存在很大差异，但截至目前，还没有关于平价医疗法案的实施将如何影响种族和族裔分布的覆盖范围的估计。我们使用微观模拟模型表明，覆盖范围的种族和族裔差异可以大大减少，这可能会使黑人-白人之间的未保险率差异减少一半以上，西班牙裔-白人之间的差异减少近四分之一。然而，预计黑人仍然比白人更有可能没有保险。在平价医疗法案下实现低水平的未保险率将取决于有效的州政策，以实现医疗补助和儿童健康保险计划以及新的保险交易所的高参与率。西班牙裔的覆盖范围增加可能取决于在加利福尼亚州和得克萨斯州采取解决语言和相关障碍的策略，这两个州有近一半的西班牙裔人口。如果未保险率如本分析中预测的那样降低，那么长期存在的在获得医疗保健和健康状况方面的种族和族裔差异很可能会减少。
