Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Gen Intern Med. 2019 Sep;34(9):1797-1805. doi: 10.1007/s11606-019-05108-1. Epub 2019 Jun 27.
Atherosclerotic cardiovascular disease (CVD) is the leading cause of death in the USA. Many with CVD or cardiovascular risk factors (CVRFs) lacked insurance coverage and access to care before enactment of the Affordable Care Act (ACA).
To assess the effect of the ACA on insurance coverage, access to care, and racial/ethnic disparities among non-elderly adults with CVD or CVRFs.
Quasi-experimental policy intervention.
Nationally representative, non-institutionalized sample of 1,014,450 adults aged 18 to 64 years with CVD or at least 2 established CVRFs in the pre-ACA (2012-2013) and post-ACA (2015-2016) periods.
Implementation of ACA provisions on 1 January 2014.
Insurance coverage, having a check-up, having a personal physician, and not having to forgo a needed physician visit because of cost.
Following ACA implementation, insurance coverage increased by 6.9 percentage points (95% CI, 6.6 to 7.2), not having to forgo a physician visit increased by 3.6 percentage points (CI, 3.3 to 3.9), having a check-up increased by 2.1 percentage points (CI, 1.8 to 2.6), and having a personal physician increased by 1 percentage point (0.6 to 1.3); changes were approximately doubled for those with lower incomes (< $35,000/year). Changes in coverage varied substantially by state and all outcomes improved more in Medicaid expansion states. Although racial/ethnic minorities had greater improvements in some outcomes, approximately 13% black and 29% Hispanic adults continued to lack coverage and access to care post-ACA.
The ACA increased coverage and access for adults with CVD or multiple CVRFs; substantial gaps remain, particularly for minorities and those in Medicaid non-expansion states.
动脉粥样硬化性心血管疾病（CVD）是美国的主要死亡原因。许多患有 CVD 或心血管风险因素（CVRFs）的人在平价医疗法案（ACA）颁布之前缺乏保险覆盖和获得医疗保健的机会。
评估 ACA 对保险覆盖范围、获得医疗保健以及患有 CVD 或 CVRFs 的非老年成年人的种族/族裔差异的影响。
准实验政策干预。
18 至 64 岁的患有 CVD 或至少有 2 种已建立的 CVRFs 的非机构化、全国代表性样本，来自于 ACA 之前（2012-2013 年）和之后（2015-2016 年）的两个时期。
2014 年 1 月 1 日实施 ACA 规定。
保险覆盖范围、进行体检、有私人医生、不必因费用而放弃所需的医生就诊。
ACA 实施后，保险覆盖范围增加了 6.9 个百分点（95%CI，6.6 至 7.2），不必放弃医生就诊的人数增加了 3.6 个百分点（95%CI，3.3 至 3.9），进行体检的人数增加了 2.1 个百分点（95%CI，1.8 至 2.6），有私人医生的人数增加了 1 个百分点（0.6 至 1.3）；收入较低（<$35,000/年）的人群变化约为两倍。各州的覆盖范围变化差异很大，所有结果在 Medicaid 扩张州都有更大的改善。尽管少数族裔在一些结果上的改善更大，但大约 13%的黑人成年人和 29%的西班牙裔成年人在 ACA 之后仍然缺乏保险和获得医疗保健的机会。
ACA 增加了患有 CVD 或多种 CVRFs 的成年人的覆盖范围和获得医疗保健的机会；但仍存在重大差距，特别是对少数民族和 Medicaid 非扩张州的人群。
