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Health Aff (Millwood). 2017 Jul 26. pii: 10.1377/hlthaff.2017.0083. doi: 10.1377/hlthaff.2017.0083. [Epub ahead of print]

The Affordable Care Act Reduced Socioeconomic Disparities In Health Care Access.

Author information

1
Kevin Griffith is a PhD student in the Department of Health Law, Policy, and Management at the Boston University School of Public Health and a health services researcher at the Veterans Affairs Boston Healthcare System, in Massachusetts.
2
Leigh Evans is a PhD candidate in the Department of Health Law, Policy, and Management at the Boston University School of Public Health and a health services researcher at the Center for Healthcare Organization and Implementation Research at the Veterans Affairs Boston Healthcare System.
3
Jacob Bor (jbor@bu.edu) is an assistant professor in the Departments of Global Health and Epidemiology at the Boston University School of Public Health.

Abstract

The United States has the largest socioeconomic disparities in health care access of any wealthy country. We assessed changes in these disparities in the United States under the Affordable Care Act (ACA). We used survey data for the period 2011-15 from the Behavioral Risk Factor Surveillance System to assess trends in insurance coverage, having a personal doctor, and avoiding medical care due to cost. All analyses were stratified by household income, education level, employment status, and home ownership status. Health care access for people in lower socioeconomic strata improved in both states that did expand eligibility for Medicaid under the ACA and states that did not. However, gains were larger in expansion states. The absolute gap in insurance coverage between people in households with annual incomes below $25,000 and those in households with incomes above $75,000 fell from 31 percent to 17 percent (a relative reduction of 46 percent) in expansion states and from 36 percent to 28 percent in nonexpansion states (a 23 percent reduction). This serves as evidence that socioeconomic disparities in health care access narrowed significantly under the ACA.

KEYWORDS:

Access To Care; Affordable Care Act; Insurance Coverage < Insurance; Medicaid; Socioeconomic Disparities

Comment in

PMID:
28747321
DOI:
10.1377/hlthaff.2017.0083

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