Racial trends in clinical preventive services use, chronic disease prevalence, and lack of insurance before and after the Affordable Care Act.

Abstract

To compare the relative change in the use of clinical preventive services, prevalence of chronic disease, and share uninsured among White, Black, and Hispanic adults before and after the introduction of the Affordable Care Act (ACA). Retrospective analysis using the Medical Expenditure Panel Survey of adults aged 18 to 64 years. The regression relies on a fully interacted set of indicator variables of each racial group by 3 time periods: 2005-2009, 2010-2013, and 2014-2018. Outcomes included indicators of mammography, colonoscopy, and lipid panel use. Several chronic conditions were examined, including diabetes, hyperlipidemia, hypertension, coronary heart disease, and mental health status. The final outcome variables examined health insurance (uninsured or not) and out-of-pocket spending as a share of family income. Regression models were used controlling for patient characteristics (age, income, education) and for a set of fully interacted indicator variables of race and time period. We tested for relative changes in White adults vs minority adults for each outcome variable. We used the Wald test (test command in Stata) to test for relative changes over time. We found reductions in baseline (pre-ACA) disparities over time in several of the measures between minority adults and White adults. This included greater growth in the use of mammograms and colonoscopies among minority populations. The results also saw relative reductions in hypertension, coronary heart disease, and fair or poor mental health. Finally, the share uninsured among Hispanic adults decreased at a faster rate than among White adults pre-ACA compared with the ACA period examined. The ACA is associated with a reduction in baseline differences in the use of some clinical preventive services, chronic disease prevalence, health insurance coverage, and out-of-pocket spending. Continued efforts to promote prevention and further expansions of coverage would appear to pay dividends.