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The Affordable Care Act’s Role in Aging Disparities Before and After Medicare Eligibility

《平价医疗法案》在医疗保险资格前后的老龄化差异中的作用

基本信息

批准号：
10681381
负责人：
Renuka Tipirneni
金额：
$ 51.88万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-15 至 2026-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10681381
关键词：
Adult Affect Affordable Care Act Age Aging American Area Black American Black Populations Black race Caring Childhood Chronic Chronic Care Chronic Disease Community Surveys Data Disadvantaged Disease Management Disparity Distress Drug Costs Economics Elderly Eligibility Determination Enrollment Ethnic Origin Ethnic Population Event Exposure to Financial Hardship Financial Support Funding Future Gender General Population Goals Health Health Insurance Health Services Accessibility Health Status Health and Retirement Study Healthcare Heterogeneity Hispanic Hispanic Populations Hospitalization Individual Insurance Coverage Interruption Intervention Life Life Cycle Stages Life Expectancy Link Medicaid Medicaid eligibility Medical Care Costs Medicare Methods Minority Modeling Natural experiment Non-Prescription Drugs Policies Privatization Race Role Socioeconomic Status Structural Racism Study models Time Time Series Analysis Vulnerable Populations Work access disparities barrier to care burden of illness care costs cost critical period disability disparity reduction ethnic disparity ethnic health disparity ethnic minority experience health care availability health care disparity health care service utilization health disparity health equity healthy aging human old age (65+)improved innovation middle age population survey racial disparity racial health disparity racial minority racial population socioeconomics treatment effect

项目摘要

PROJECT SUMMARY / ABSTRACT Despite recent gains in overall life expectancy in the US, racial/ethnic health disparities in older adults (age ≥65) persist and are widening. This includes disparities in health status, chronic disease burden, disability, and life expectancy for Black and Hispanic older adults compared with whites. Our previous work has identified mid-life (age 50-64) as a critical period when health disparities for racial/ethnic minorities are set and may potentially be intervened upon. The Affordable Care Act coverage expansions of 2014 have shown promise for reducing disparities in access and health, but the impact on middle-aged and older adults has been largely understudied. The overarching goal of this proposal is to examine whether exposure to ACA coverage (Medicaid and Marketplace plans) and access to care for middle-aged adults (age 50-64) may affect downstream health disparities in older adults (age ≥65). We will use two modeling approaches in all aims: a) interrupted time series analysis to assess the impact of the entire ACA coverage expansion on racial/ethnic disparities before vs. after 2014; and b) difference-in-differences (DID) analysis and event study models comparing Medicaid expansion vs. non-expansion states estimated for each racial/ethnic group (Black, Hispanic, white) to assess the specific impact of Medicaid on disparities. In all analyses, we will also examine heterogeneity of treatment effects by individual-level intersecting identities (race, ethnicity, gender, socioeconomic status) and area-level structural racism. With this approach, we will achieve the following specific aims: 1) Assess how racial/ethnic disparities in middle-aged adults’ health insurance coverage has changed before vs. after the ACA coverage expansions, using the American Community Survey; 2) Estimate racial/ethnic disparities in middle-aged adults’ health care access and out-of-pocket costs before and after the ACA coverage expansions, using the Health and Retirement Study (HRS) and the Current Population Survey; and 3) Investigate racial/ethnic disparities in middle-aged and older adults’ health, and older adults’ health care utilization and costs before and after the ACA, using the HRS-linked Medicare data. The proposed work is significant because, in a time of economic distress and worsening health disparities, it will directly inform US health insurance policies to improve health equity for vulnerable populations. The methods are innovative in using the natural experiment of the ACA and an explicit focus on structural racism to understand whether the upstream policy intervention of the ACA that affected coverage of middle-aged adults may impact trajectories of health and health care disparities of middle-aged and older adults as they age.

项目概要/摘要尽管美国的总体预期寿命最近有所提高，但老年人（年龄 ≥65）持续存在并且正在扩大。这包括健康状况、慢性病负担、残疾和健康状况方面的差异黑人和西班牙裔老年人与白人相比的预期寿命。我们之前的工作已经确定中年（50-64岁）是少数种族/族裔健康差异出现的关键时期，并且可能会出现这种情况。可能会受到干预。 2014 年《平价医疗法案》覆盖范围的扩大已显示出对减少了获取和健康方面的差距，但对中老年人的影响在很大程度上是待研究。该提案的总体目标是检查是否接触 ACA 保险（医疗补助和医疗补助）市场计划）和中年人（50-64 岁）获得护理的机会可能会影响下游健康老年人（年龄≥65 岁）的差异。我们将在所有目标中使用两种建模方法：a）中断时间系列分析，以评估整个 ACA 覆盖范围扩大之前对种族/民族差异的影响与 2014 年之后相比； b) 比较医疗补助的双重差分 (DID) 分析和事件研究模型针对每个种族/族裔群体（黑人、西班牙裔、白人）估计的扩张州与非扩张州的情况进行评估医疗补助对不平等的具体影响。在所有分析中，我们还将检查治疗的异质性个人层面交叉身份（种族、族裔、性别、社会经济地位）和地区层面的影响结构性种族主义。通过这种方法，我们将实现以下具体目标： 1) 评估种族/民族差异如何影响中年成年人的健康保险覆盖范围在 ACA 覆盖范围扩大之前与之后发生了变化，使用美国社区调查； 2）估计中年人医疗保健中的种族/民族差异使用 Health 和 ACA 扩大覆盖范围之前和之后的接入和自付费用退休研究（HRS）和当前人口调查； 3) 调查种族/民族差异中老年人健康状况、老年人医疗保健利用情况和医疗费用前后情况 ACA，使用 HRS 链接的医疗保险数据。拟议的工作意义重大，因为在经济困难和健康差距日益恶化的时期，将直接告知美国健康保险政策，以改善弱势群体的健康公平。这方法是创新的，利用 ACA 的自然实验，并明确关注结构性种族主义了解ACA的上游政策干预是否影响了中年人的覆盖范围随着年龄的增长，可能会影响中老年人的健康轨迹和医疗保健差异。