Closing Racial Disparities Through the Affordable Care Act: Medicaid Expansion, Marketplaces, Federally Qualified Community Health Centers

通过《平价医疗法案》缩小种族差异：医疗补助扩张、市场、联邦合格的社区卫生中心

• 批准号: 10717603
• 负责人: LONNIE Roscoe SNOWDEN
• 金额: $ 42.95万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-20 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10717603
• 关键词: Address; Adult; Affect; Affordable Care Act; African American; African American population; Area; Automobile Driving; Black Populations; Caring; Characteristics; Country; County; Criminal Justice; Data; Data Sources; Disadvantaged; Disparity; Drug usage; Eligibility Determination; Enrollment; Equity; Federally Qualified Health Center; Future; Health; Health Insurance; Health Policy; Healthcare; Heterogeneity; Income; Individual; Institutional Racism; Institutionalization; Insurance; Insurance Coverage; Measures; Medicaid; Mental Health; Mental Health Services; Mental disorders; Mentally Ill Persons; Monitor; National Institute of Mental Health; Neighborhood Health Center; Not Hispanic or Latino; Outcome; Persons; Play; Policies; Population Heterogeneity; Poverty; Privatization; Provider; Qualifying; Racial Equity; Reporting; Research; Running; Shapes; Stigmatization; Strategic Planning; Structural Racism; Structure; Surveys; System; Time; Underserved Population; Unemployment; Uninsured; United States Health Resources and Services Administration; Work; aged; copayment; disparity reduction; ethnic diversity; federal policy; health disparity; health equity; improved; programs; psychological distress; racial disparity; racism; safety net; severe mental illness; sociodemographic variables; success; treatment disparity; uptake; waiver

Project Summary/Abstract The now established Affordable Care Act (ACA) afforded an opportunity to increase mental health coverage and treatment for African Americans and whites and to reduce disparities. By extending Medicaid coverage to adults with incomes at or below 138% of the Federal Poverty Line (FPL), providing purchase subsidies for adults with incomes between 100% and 400% FPL, and by increasing the supply of Federally Qualified Health Centers which provide considerable mental health care nationwide, the ACA can benefit uninsured African Americans with mental health problems especially. We know little about how much ACA policies increased coverage and treatment for mentally ill Blacks and whites. Using data from the National Survey on Drug Use and Health (NSDUH), the Health Resources and Services Administration and from various Medicaid and marketplace data sources this study asks, for the first time, the following: For persons aged 18-64 with Mild and Moderate Mental Illness (MMMI), Serious Mental illness (SMI), and Serious Psychological Distress (SPD), and after controlling for individual socio-demographic variables related to insurance uptake and/or receipt of mental health treatment and key state-level differences we ask: (1) How much did the ACA Medicaid expansion increase Medicaid coverage and reduce coverage disparities? How was disparity reduction limited by some states’ supplemental Medicaid requirements? (2) How much did increases in 1) ACA Medicaid coverage (2) greater FQHC availability increase but lack of other provider availability decrease mental health treatment for African Americans and reduce African American- white disparities? How much did ACA marketplaces for subsidized purchase increase private coverage and reduce disparities? How much did increases in 1) marketplace coverage (2) and greater FQHC availability increase, but lack of other provider availability decrease mental health treatment for African Americans and reduce African American-white disparities? The ACA is status quo, and it is important to provide evidence concerning African American-white mental health coverage and treatment disparity reduction to monitor progress and guide future disparity reduction policy and administrative actions.

项目总结/文摘