Pickett Stephen, Marks Elena, Ho Vivian
Stephen Pickett is with the Department of Economics, Rice University, Houston, TX. Elena Marks is with the Episcopal Health Foundation, Houston, and the Baker Institute for Public Policy, Rice University. Vivian Ho is with the Baker Institute for Public Policy and the Department of Medicine, Baylor College of Medicine, Houston.
Am J Public Health. 2017 Jan;107(1):120-126. doi: 10.2105/AJPH.2016.303510. Epub 2016 Nov 17.
To examine the effects of the Affordable Care Act's (ACA's) Marketplace on Texas residents and determine which population subgroups benefited the most and which the least.
We analyzed insurance coverage rates among nonelderly Texas adults using the Health Reform Monitoring Survey-Texas from September 2013, just before the first open enrollment period in the Marketplace, through March 2016.
Texas has experienced a roughly 6-percentage-point increase in insurance coverage (from 74.7% to 80.6%; P = .012) after implementation of the major insurance provisions of the ACA. The 4 subgroups with the largest increases in adjusted insurance coverage between 2013 and 2016 were persons aged 50 to 64 years (12.1 percentage points; P = .002), Hispanics (10.9 percentage points; P = .002), persons reporting fair or poor health status (10.2 percentage points; P = .038), and those with a high school diploma as their highest educational attainment (9.2 percentage points; P = .023).
Many population subgroups have benefited from the ACA's Marketplace, but approximately 3 million Texas residents still lack health coverage. Adopting the ACA's Medicaid expansion is a means to address the lack of coverage.
研究《平价医疗法案》（ACA）的市场对德克萨斯州居民的影响，并确定哪些人群亚组受益最大，哪些受益最小。
我们使用2013年9月（就在市场首次开放注册期之前）至2016年3月的《德克萨斯州医疗改革监测调查》，分析了德克萨斯州非老年成年人的保险覆盖率。
在实施ACA的主要保险条款后，德克萨斯州的保险覆盖率大致提高了6个百分点（从74.7%提高到80.6%；P = 0.012）。2013年至2016年期间，调整后保险覆盖率增幅最大的4个人群亚组分别是50至64岁的人群（12.1个百分点；P = 0.002）、西班牙裔（10.9个百分点；P = 0.002）、自我报告健康状况为一般或较差的人群（10.2个百分点；P = 0.038）以及最高学历为高中文凭的人群（9.2个百分点；P = 0.023）。
许多人群亚组受益于ACA的市场，但仍有大约300万德克萨斯州居民缺乏医疗保险。采用ACA的医疗补助扩大计划是解决保险覆盖不足问题的一种方式。
