John J. Park ( john. park@mail. harvard. edu ) is a Knox Fellow in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts.
Benjamin D. Sommers is a professor of health policy and economics in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, and a professor of medicine at Brigham and Women's Hospital, in Boston.
Health Aff (Millwood). 2019 Nov;38(11):1911-1917. doi: 10.1377/hlthaff.2019.00316.
To determine how low-income Asian American, Native Hawaiian, and Pacific Islander (AANHPI) adults gained health insurance coverage-specifically, via Medicaid or private insurance-under the Affordable Care Act, we used a difference-in-differences approach to compare uninsurance rates in 2010-13 and 2015-16. In Medicaid expansion states, adjusted Medicaid coverage gains were 9.67 percentage points larger than in nonexpansion states; however, adjusted private coverage gains in expansion states were 10.19 percentage points lower. These results indicate that, in contrast to the case for other racial/ethnic groups, for AANHPI the Medicaid coverage increases in expansion states were of similar magnitude to the private insurance coverage increases in nonexpansion states. Reasons for this may include differences in willingness to enroll in public versus private coverage, barriers related to language or citizenship status, or other factors. Future studies are needed to understand these patterns and promote health equity for this population.
为了确定低收入亚裔美国人、夏威夷原住民和太平洋岛民(AANHPI)成年人是如何通过《平价医疗法案》获得医疗保险覆盖的,具体来说,是通过医疗补助计划还是私人保险,我们采用了双重差分法来比较 2010-13 年和 2015-16 年的未参保率。在医疗补助计划扩大的州,调整后的医疗补助计划覆盖范围的增长幅度比非扩大州高出 9.67 个百分点;然而,在扩大州,调整后的私人保险覆盖范围的增长幅度比非扩大州低 10.19 个百分点。这些结果表明,与其他种族/族裔群体的情况不同,对于 AANHPI 来说,扩大州的医疗补助计划覆盖范围的增长幅度与非扩大州的私人保险覆盖范围的增长幅度相当。造成这种情况的原因可能包括参保公共保险与私人保险的意愿差异、与语言或公民身份相关的障碍,或其他因素。未来的研究需要了解这些模式,并为这一人群促进健康公平。