Study: Obamacare benefitted Latinos, butpersistent disparities remain9 January 2017, by Frank Otto

Credit: Drexel University

The implementation of the Affordable Care Actimproved health care access and utilization amongLatinos, a new study found, although somepersistent disparities do remain years later.

The authors of the study, released amidst seriousdiscussions in Congress on repealing andreplacing the Affordable Care Act (ACA orObamacare), believe an effective way to combatremaining disparities is to expand the law,especially to those excluded from it—such as thosewho recently obtained a green card or undocumented immigrants.

"The uninsured rate has dropped by more than halffor Latinos," said Alex Ortega, PhD, professor inDrexel University's Dornsife School of PublicHealth and senior author of the study. "We shouldcontinue to improve communication and outreachregarding the benefits of the legislation andimprove messaging to groups that are hard toreach or enroll. The government should not bechanging the ACA right when people are using itand enrolling."

Ortega's former trainee at UCLA, Héctor Alcalá,PhD, (now at the University of Virginia), led thestudy that put a microscope on the ACA's impact onspecific Latino heritage groups, who historicallyhave had poorer access to and utilization of healthcare than non-Latino whites.

Alcalá, Ortega and their research team investigatedthe impact by accessing data from the NationalHealth Interview Survey from the years 2011through 2015, a period that started with theimplementation of some of the ACA's provisions.Although they found that all groups (including non-Latino whites) experienced increases in thepercentage of those insured, utilization and accessto health care fluctuated from group to group.

"While there were positive increases in most Latinoheritage groups right after the ACA implementation,we observed some negatives in more recent years,such as some groups displaying increases inforgoing or delaying medical care," explainedAlcalá, who served as the first author on the study,which was published in the Journal of AmericanBoard of Family Medicine.

Progress was not universal across the categoriesthe study looked into rates of those insured, delayin seeking necessary care, forgoing necessarycare, emergency department use and physicianvisits. Some Latino heritage groups displayedimportant gains in some categories but laggedbehind others in other categories.

For example, between 2011 and 2015, Alcalá andOrtega's team found that Puerto Ricans andMexicans displayed a sizable decrease in delay ofseeking necessary medical care (around half foreach). Meanwhile, Cubans and Central Americansboth continued to display a high rate of delayingnecessary care (22 percent more likely and 10percent more likely than non-Latino whites,respectively), with fluctuations down and upoccurring.

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When it came to completely forgoing care, Cubansshowed a sharp improvement between 2013 and2014 (52 percent reduction), but trended backtoward disparity in 2015 (27 percent increase afterall ACA provisions were implemented). CentralAmericans also showed a decline in forgoing carein the period right after early provisions of theAffordable Care Act were put into place (47 percentdecline from 2011 to 2013), but have since trendedbackward.

Persistent disparities in access to and utilization ofhealth care were found between non-citizens,naturalized citizens and U.S.-born citizens. Non-citizens and naturalized individuals saw no gainsafter all provisions of the Affordable Care Act wereimplemented, according to the study's findings.

Such deficiencies could result from undocumentedimmigrants not being eligible for benefits throughthe Affordable Care Act and lawful permanentresidents (who are not citizens) needing to have agreen card for five years before getting coveragethrough the health law's expansion of Medicaid.

"If a recent permanent resident is earning very littlemoney and not allowed into Medicaid, they mayface a problem paying for premiums and the cost-sharing that is required even in subsidizedpremiums and cost-sharing," Ortega explained.

Additionally, it was found that disparities remainedby language. Those who were interviewed inSpanish for the National Health Interview Surveywere far less likely than those who wereinterviewed in English to be insured (20 percentless so), use an emergency department (40 percentless) or have a primary care visit (20 percent less).The Affordable Care Act seemed to bring nochange.

"The picture is less clear when it comes tolanguage," Ortega said. "Because our measure didnot assess language proficiency, it is possible thatdisparities did decrease by language proficiencyand we were not able to observe this phenomenoncompletely."

Alcalá called large-scale reforms like the AffordableCare Act "critical" for improving the United States'

overall population health. But there are other factorsthat could be targeted that might reduce healthdisparities.

"Legislation not targeting the health care systemdirectly, but things like social security,environmental regulations, minimum wage,occupational safety and taxation policy, has animpact," Alcalá said. "As rollbacks and repeals tothe ACA are contemplated, the public andpolicymakers must consider other options toimprove population health."

More information: "Impact of the Affordable CareAct on Health Care Access and Utilization AmongLatinos," DOI: 10.3122/jabfm.2017.01.160 ,http://www.jabfm.org/content/30/1/52.abstract

Provided by Drexel University

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APA citation: Study: Obamacare benefitted Latinos, but persistent disparities remain (2017, January 9)retrieved 6 July 2018 from https://medicalxpress.com/news/2017-01-obamacare-benefitted-latinos-persistent-disparities.html

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