摘要：Objectives. We examined prereform patterns in insurance coverage, access to care, and preventive services use by race/ethnicity in adults targeted by the coverage expansions of the Patient Protection and Affordable Care Act (ACA). Methods. We used pre-ACA household data from the Medical Expenditure Panel Survey to identify groups targeted by the coverage provisions of the Act (Medicaid expansions and subsidized Marketplace coverage). We examined racial/ethnic differences in coverage, access to care, and preventive service use, across and within ACA relevant subgroups from 2005 to 2010. The study took place at the Agency for Healthcare Research and Quality in Rockville, Maryland. Results. Minorities were disproportionately represented among those targeted by the coverage provisions of the ACA. Targeted groups had lower rates of coverage, access to care, and preventive services use, and racial/ethnic disparities were, in some cases, widest within these targeted groups. Conclusions. Our findings highlighted the opportunity of the ACA to not only to improve coverage, access, and use for all racial/ethnic groups, but also to narrow racial/ethnic disparities in these outcomes. Our results might have particular importance for states that are deciding whether to implement the ACA Medicaid expansions. The existence of persistent racial/ethnic disparities in insurance coverage, access to medical care, and adherence to preventive services recommendations has been well documented. 1–7 Reducing disparities such as these is a core objective of the Patient Protection and Affordable Care Act (ACA; Pub L No. 111–148). In this study, we used the Medical Expenditure Panel Survey (MEPS) to take a detailed look at disparities in coverage, access to care, and preventive services use among adults aged 19 to 64 years, and we examined these disparities against the backdrop of the coverage provisions of the ACA. The ACA contains numerous provisions that directly or indirectly seek to reduce disparities in health care. As a result of ACA coverage provisions, more than half of all states and the District of Columbia (DC) now provide Medicaid up to 138% of poverty, 8 and subsidized Marketplace coverage is available in all states and DC, between 100% and 400% of poverty, to those who are ineligible for public coverage and who are not offered affordable employer-sponsored insurance (ESI). The ACA includes preventive services mandates (for non-grandfathered, non–self-insured private plans) and federal incentives for states to cover preventive screening under Medicaid and to improve care coordination. The ACA also contains numerous other provisions aimed at reducing disparities, including enhanced federal monitoring, incentives to increase provider cultural competency, and more. 9,10 The effect of these provisions on disparities in health care will depend in large measure on what Eisenberg and Power 11 termed the “voltage drops” associated with incomplete take-up of coverage by eligible individuals, the care-seeking behavior of newly insured individuals, and the ability of the health care system to accommodate increased demand. 12 The full extent of these voltage drops may be unknown for several more years, because the full effects of the ACA are not expected to be observed until 2016 or beyond, especially for services that are not recommended on an annual basis. Nevertheless, it is possible to gain insights into the potential impact of the ACA by examining the pre-reform disparities in coverage, access, and preventive care use across the groups the ACA targeted for coverage expansions. We examined households from 2005 to 2010, a period before implementation of the main coverage provisions of the ACA. We examined the extent to which minorities were disproportionately represented among the groups targeted for coverage expansions, and we identified pre-reform disparities, by ACA coverage groups, in coverage, access to care, and preventive services use. Our analysis examined the opportunity of the ACA not only to improve coverage, access, and use for all racial and ethnic groups, but also to narrow the racial/ethnic disparities in these outcomes. The study took place at the Agency for Healthcare Research and Quality (AHRQ) in Rockville, Maryland.
