Will the Affordable Care Act (ACA) Improve Racial/Ethnic Disparity of Eye Examination Among US Working-Age Population with Diabetes?

Abstract

This study aimed to examine the racial/ethnic disparity of eye examination rates among US adults with diabetes before and after the ACA. Working-age adults (18-64years) with diabetes for years 2014-2017 were simulated by bootstrapping from the working-age diabetes patient sample of Medical Expenditure Panel Survey (MEPS) Household Component 2011. Insurance coverage rates were separately predicted for each racial/ethnic group based on the Congressional Budgeting Office (CBO) report in 2014 and the proportions of Medicaid eligibility. Eye examination rates were weighted to national estimates and compared between racial/ethnic groups. Confidence intervals were estimated using the bootstrap percentile method. Health insurance coverage after the ACA is projected to increase from 90.23% in 2011 to 98.33% in 2014 among non-Hispanic Whites (NHW), reaching 98.96% in 2017. Minorities are forecasted to have about 15% expansion of insurance coverage from 2011 (80.65%) to 2014 (96.00%), reaching 97.25% in 2017. In 2011, 63.01% of NHW had eye examinations with forecasted increase to 65.83% in 2014 and 66.05% in 2017, while the eye examination rate in the minorities will increase from 55.75% in 2011 to 59.23% in 2014 and remain at 59.48% in 2017. Therefore, racial disparity in eye examination rates is forecasted to persist (ranging from 6.57% in 2017 to 6.69% in 2016). The ACA is projected to improve the eye examination rate along with the expansion in insurance coverage. Although predicted racial/ethnic disparities will improve, some differences will persist. Comprehensive strategies need to be developed to eliminate the disparity.