Health Care DisparitiesInsurance Coverage and Well-Child Visits Improved for Youth Under the Affordable Care Act, but Latino Youth Still Lag Behind
Section snippets
Methods
We use data for 64,565 youth ages 0 to 17 years in the 2011 to 2015 National Health Interview Survey (NHIS) child component. NHIS is a cross-sectional, nationally representative, telephone survey of the civilian, noninstitutionalized population in the United States. The survey provides estimates of health indicators, insurance coverage, and utilization as well as socioeconomic and demographic information. If one or more youth was present in the sampled household, one youth was randomly selected
Analyses
All analyses were conducted using Stata Statistical Software: Release 14 (StataCorp LP, College Station, Texas).16 Sampling weights and design variables were used to create nationally representative estimates and to account for differential nonresponse and the complex design of the survey using the svy suite of commands. First, we summarized the trends of health care access and utilization according to race/ethnicity over the 2011 to 2015 sample frame. Second, we conducted separate multivariate
Results
The Figure shows parent-reported health insurance coverage and utilization across the pre- and post-ACA periods stratified according to race and ethnicity. Uninsurance decreased significantly for all race/ethnic groups after national implementation of the ACA. Specifically, the uninsured rates decreased by 1 percentage point for white youth (from 5% pre-ACA to 4% in post-ACA) and 1 percentage point for black youth (5% to 4%). Latino youth experienced the largest absolute reduction in
Discussion
The passage of the ACA represented an important opportunity to improve access and utilization of health care services for youth. The current study shows that, in general, levels of insurance coverage and well-child visits improved between the pre- and post-ACA periods (2011–2013 vs 2014–2015) for all racial/ethnic groups of youth. Latino youth had the largest absolute gain in insurance coverage, but still had the highest absolute levels of uninsurance in the post-ACA period and had significant
Conclusions
This study shows that the ACA resulted in substantial gains in insurance coverage and well-child visits for all youth, although some inequities, particularly for Latino youth, still persist. Policy makers should consider whether the short-term economic and political gains of repealing and replacing all or parts of the ACA are worth rolling back improvements in access to and utilization of health care that have taken place over the past 5 years. If the federal government does repeal the ACA,
Acknowledgments
Authorship Statement: A.N.O. conceptualized and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted. R.M.M. helped interpret the results, contributed to the initial drafting of the manuscript, reviewed and revised the manuscript, and approved the final manuscript as submitted. J.C. carried out the analyses, contributed to the initial drafting of the manuscript, reviewed and revised the manuscript, and approved the final manuscript as submitted.
References (30)
- et al.
A national and state profile of leading health problems and health care quality for US children: key insurance disparities and across-state variations
Acad Pediatr
(2011) Immigration enforcement and mixed-status families: the effects of risk of deportation on Medicaid use
Child Youth Serv Rev
(2015)- et al.
Key provisions of the Patient Protection and Affordable Care Act (ACA): a systematic review and presentation of early research findings
Health Serv Res
(2016) - et al.
Health insurance coverage: early release of estimates from the National Health Interview Survey, January-June 2014
(2014) - et al.
Racial and ethnic disparities in health care access and utilization under the Affordable Care Act
Med Care
(2016) - et al.
Taking stock: gains in health insurance coverage under the ACA as of March 2015
- et al.
Health insurance coverage and the Affordable Care Act, 2010-2016
- et al.
Health Insurance coverage: early release of estimates from the National Health Interview Survey, January-March 2016
- et al.
Impact of the Affordable Care Act on health care access and utilization among Latinos
J Am Board Fam Med
(2017) - et al.
Quality of health insurance coverage and access to care for children in low-income families
JAMA Pediatr
(2016)
Health insurance coverage of children 0-18
Differences in health care needs, health care utilization, and health care outcomes among children with special health care needs in Ohio: a comparative analysis between Medicaid and private insurance
J Public Health Manag Pract
A “cap” on Medicaid: how block grants, per capita caps, and capped allotments might fundamentally change the safety net
Policy Brief UCLA Cent Health Policy Res. PB
Health care reform: ObamaCare reform timeline
Improving access to care
Cited by (0)
The authors have no conflicts of interest to disclose.