Lipton Brandy J, Decker Sandra L, Sommers Benjamin D
1 Agency for Healthcare Research and Quality, Rockville, MD, USA.
2 Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Med Care Res Rev. 2019 Feb;76(1):32-55. doi: 10.1177/1077558717706575. Epub 2017 Apr 27.
Prior to the Affordable Care Act, one in three young adults aged 19 to 25 years were uninsured, with substantial racial/ethnic disparities in coverage. We analyzed the separate and cumulative changes in racial/ethnic disparities in coverage and access to care among young adults after implementation of the Affordable Care Act's 2010 dependent coverage provision and 2014 Medicaid and Marketplace expansions. We find that the dependent coverage provision was associated with similar gains across racial/ethnic groups, but the 2014 expansion was associated with larger gains in coverage among Hispanics and Blacks relative to Whites. After the 2014 expansion, coverage increased by 11.0 and 10.1 percentage points among Hispanics and Blacks, respectively, compared with a 5.6 percentage point increase among Whites. The percentage with a usual source of care and a recent doctor's visit also increased more for Blacks relative to Whites. Increases in coverage were larger in Medicaid expansion compared with nonexpansion states for most racial/ethnic groups.
在《平价医疗法案》出台之前，19至25岁的年轻成年人中有三分之一没有医疗保险，保险覆盖方面存在显著的种族/族裔差异。我们分析了在《平价医疗法案》2010年受抚养人保险条款以及2014年医疗补助和市场扩展实施后，年轻成年人在保险覆盖和获得医疗服务方面种族/族裔差异的单独及累积变化。我们发现，受抚养人保险条款在各种族/族裔群体中带来的收益相似，但2014年的扩展相对于白人而言，在西班牙裔和黑人中带来了更大的保险覆盖收益。2014年扩展之后，西班牙裔和黑人的保险覆盖率分别提高了11.0和10.1个百分点，而白人仅提高了5.6个百分点。相对于白人，黑人中拥有常规医疗服务来源且近期看过医生的比例增长也更大。对于大多数种族/族裔群体而言，与未扩展的州相比，医疗补助扩展州的保险覆盖率增长幅度更大。
