Elsevier

Academic Pediatrics

Volume 18, Issue 1, January–February 2018, Pages 35-42
Academic Pediatrics

Health Care Disparities
Insurance Coverage and Well-Child Visits Improved for Youth Under the Affordable Care Act, but Latino Youth Still Lag Behind

https://doi.org/10.1016/j.acap.2017.07.006Get rights and content

Abstract

Objective

To examine whether there have been changes in insurance coverage and health care utilization for youth before and after the national implementation of the Patient Protection and Affordable Care Act (ACA) and to assess whether racial and ethnic inequities have improved.

Methods

Data are from 64,565 youth (ages 0–17 years) participants in the 2011 to 2015 National Health Interview Survey. We conducted multivariate logistic regression analyses to determine how the period after national implementation of the ACA (years 2011–2013 vs years 2014–2015) was associated with health insurance coverage and utilization of health care services (well-child visits, having visited an emergency department, and having visited a physician, all in the past 12 months), and whether changes over the pre- and post-ACA periods varied according to race and Latino ethnicity.

Results

The post-ACA period was associated with improvements in insurance coverage and well-child visits for all youth. Latino youth had the largest absolute gain in insurance coverage; however, they continued to have the highest proportion of uninsurance post national ACA implementation. With regard to health care equity, non-Latino black youth were less likely to be uninsured and Latino youth had no significant improvements in insurance coverage relative to non-Latino white youth after national ACA implementation. Inequities in health care utilization for non-Latino black and Latino youth relative to non-Latino white youth did not improve.

Conclusions

Insurance coverage and well-child visits have significantly improved for all youth since passage of the ACA, but inequities persist, especially for Latino youth.

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.

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    The authors have no conflicts of interest to disclose.

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