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

项目总结/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 #25655;，并不断扩大。这包括健康状况、慢性疾病负担、残疾和 黑人和西班牙裔老年人的预期寿命与白人相比。我们之前的工作已经确定了 中年（50-64岁）是少数种族/族裔健康差异形成的关键时期， 有可能被干预。2014年《平价医疗法案》的覆盖范围扩大表明， 减少在获得和健康方面的差距，但对中年和老年人的影响主要是 替补演员 该提案的总体目标是检查是否暴露于ACA覆盖范围（医疗补助和 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覆盖范围扩大对种族/民族差异的影响， vs. 2014年之后;以及B）差异中差异（DID）分析和事件研究模型， 估计每个人种/种族组（黑人、西班牙裔、白色）的扩展与非扩展状态，以评估 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/民族差异如何在 中年人的健康保险覆盖范围在ACA覆盖范围扩大之前和之后发生了变化， 使用美国社区调查; 2）估计中年成人医疗保健中的种族/民族差异 在ACA覆盖范围扩大之前和之后的访问和自付费用，使用健康和 退休研究（HRS）和当前人口调查;以及3）调查 中老年人的健康状况，以及老年人的医疗保健利用和费用， ACA，使用与HRS相关的医疗保险数据。 拟议的工作意义重大，因为在经济困难和健康差距恶化的时期， 将直接告知美国医疗保险政策，以改善弱势群体的健康公平性。的 方法是创新的，使用ACA的自然实验和明确的重点是结构性种族主义， 了解ACA的上游政策干预是否影响了中年人的覆盖率 可能会影响中年和老年人随着年龄增长的健康和医疗保健差距的轨迹。

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.