In Low-Income Latino Patients, Post-Affordable Care Act Insurance Disparities May Be Reduced Even More than Broader National Estimates: Evidence from Oregon
In Low-Income Latino Patients, Post-Affordable Care Act Insurance Disparities May Be Reduced Even More than Broader National Estimates: Evidence from Oregon
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DOI：
10.1007/s40615-016-0232-1
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发表时间：
2017-06-01
影响因子：
3.9
通讯作者：
Marino, Miguel
中科院分区：
文献类型：
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作者：
Heintzman, John;Bailey, Steffani R.;Marino, Miguel
背景早期调查证据表明，在平价医疗法案(ACA)之后，拉美裔和非西班牙裔白人之间的保险覆盖差距缩小。这些发现可能不能描述在这一政策变化过程中，在社区卫生中心(CHC)服务的脆弱、低收入拉丁裔人口的保险状况。横断面调查在描述医疗保险状况变化等纵向现象方面也可能用处有限。方法使用电子健康记录(EHR)数据，我们比较了俄勒冈州23家CHC中N=42,392名低收入患者在2014年1月1日实施ACA相关医疗补助扩展的6年期间按种族/民族和语言提供的保险状况。结果在2014年前，更喜欢西班牙语的拉丁裔比更喜欢英语的拉丁裔和非西班牙裔白人更有可能没有保险。在2014年至少返回一次就诊的未参保患者中，更喜欢西班牙语的拉丁裔患者的保险覆盖率增幅最大，所有三个种族/民族/语言群体的保险覆盖率都相似。2014年有来访和没有来访的患者之间没有种族/民族/语言差异。结论在返回俄勒冈州CHCs的以前没有保险的低收入患者中，医疗补助扩大后，保险差距消除了，特别是在讲西班牙语的拉丁裔患者中。需要进一步的研究来了解这一队列中保险差距的消除情况。
Background Early survey evidence suggests a reduction of disparities in insurance coverage between Latinos and nonHispanic Whites post-Affordable Care Act (ACA). These findings may not describe the insurance status of vulnerable, low-income Latino populations served in community health centers (CHCs) over the course of this policy change. Crosssectional surveys also may be of limited use in describing longitudinal phenomena such as changes in health insurance status.Methods Using electronic health record (EHR) data, we compared the insurance status of N = 42,392 low-income patients served in 23 CHCs in Oregon, by race/ethnicity and language, over a period of 6 years straddling the implementation of ACA-related Medicaid expansion on January 1, 2014.Findings Prior to 2014, Spanish-preferring Latinos were more likely to be uninsured than English-preferring Latinos and non-Hispanic Whites. Among uninsured patients who returned for at least one visit in 2014, Spanish-preferring Latinos had the largest increase in insurance coverage rates, and all three racial/ethnic/language groups had similar rates of insurance coverage. There were no racial/ethnic/language differences between those who did and did not have visit in 2014.Conclusion Among previously uninsured low-income patients returning to Oregon CHCs, insurance disparities were eliminated after Medicaid expansion, especially in Spanishspeaking Latinos. Further study is needed to understand the elimination of insurance disparities in this cohort.