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Ways the Affordable Care Act reduced healthcare disparities

Reductions in uninsured rates ranged from -14.3 percent in the Guamanian or Chamorro subgroup to -4.1 percent in the Japanese subgroup.

Jeff Lagasse, Associate Editor

Following passage of the Affordable Care Act in 2010, the rate of Asian Americans, Native Hawaiians and Pacific Islanders without health insurance dropped to 9 percent, a rate essentially equal to that of their Caucasian counterparts, according to a study published in JAMA Internal Medicine.

The new findings are being published just as former Health and Human Services Secretary Tom Price, MD, has said that ending the individual mandate of the ACA would result in young and healthy people dropping out of the market, raising insurance prices for those who remain.

In 2009, the Veterans Health Administration, a part of the Department of Veterans Affairs, began implementing patient-centered medical homes on a national scale -- what's known as the Patient Aligned Care Team Initiative. In that year, all groups -- African Americans, Native Americans, Hispanics, Asians and Pacific Islanders -- lagged behind caucasians when it came to care quality. In 2014, the disparity for hypertension was similar for African Americans and improved only slightly for Hispanics, while multiracial individuals pulled even with whites. Native Americans and Pacific Islander experienced greater disparities over that time.

And in 2016, The Centers for Medicare and Medicaid Services released data highlighting the racial and ethnic disparities in patient experience and clinical care measures for Medicare Advantage beneficiaries. The data in disparity of care for eight patient experience measures showed that in seven areas, Asians and Pacific Islanders rated their experience in scores worse than that of whites, compared to five areas for Hispanics, three areas for blacks and only two areas for American Indians and Alaska natives. Patient experience measures included getting appointments and care quickly, getting needed prescription drugs and receiving flu vaccines.

Today, the Asian American and Pacific Islanders, collectively known as AANHPIs, is the fastest-growing racial and ethnic group in the U.S., encompassing more than 50 ethnicities and 100 languages, the authors said.

"The ACA appears to have levelled disparities in health insurance coverage between minority groups, while also ensuring that we can collect this data in the first place," said first author John Park of the Harvard Chan School, in a statement. "The ACA requires that all federally-funded health surveys of self-reported information collect disaggregated data for racial minorities who may have been invisible in the past."

The researchers analyzed data from the American Community Survey, which collects demographic data from 295,000 households annually. They calculated changes in the uninsured rate among adults before the ACA's major coverage expansions, a period from 2009-2013, and after, from 2015-2016.

People in all AANHPI subgroups saw coverage gains under the ACA. Reductions in uninsured rates ranged from -14.3 percent in the Guamanian or Chamorro subgroup to -4.1 percent in the Japanese subgroup.

While the study is the first to examine AANHPIs specifically, other research has also pointed to care gaps that exist for racial and ethnic groups; one, published in Health Affairs in June of last year, found disparities existed when it came to diabetes and hypertension control treated at patient-centered medical homes.

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