Examining the Impact of the Affordable Care Act on Access to Care for Black Men and White Men: Implications for Policy and Practice

• Main Author: Enyia, Okechuku Kelechi
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2024
• Subjects: Black studies; Public health; Public policy
• ISBN: 9798381376982

Black men experience poor health outcomes across a spectrum of chronic medical conditions and co-morbidities that ultimately lead to lower quality of life and premature death. Lack of access to medical care is one of many factors that contributes to these poor outcomes. This study examines the impact of the Patient Protection and Affordable Care Act of 2010 (ACA) on Black men’s access to care compared to White men ages 18-64; and proposes strategies to help address any inequities. The ACA undergirds this study because it includes several provisions that are specifically meant to help address racial and ethnic health disparities and improve health outcomes.This study took a longitudinal approach by examining access to care among non-Hispanic Black men and non-Hispanic White men ages 18-64 from 2011-2019. Using a publicly available secondary data source, the Medical Expenditure Panel Survey (MEPS), a descriptive and multi-variate analysis was conducted to examine the relationship between race, sociodemographic characteristics, and two indicators of health care access (insurance status and usual source of care). To statistically test hypotheses regarding the impact of the ACA on racial differences in these two indicators, an interaction term for race and two time periods (2011-2014 vs. 2015-2019) was included in regression models.The analysis found that the ACA decreased the proportions of non-Hispanic Black men and non-Hispanic White men who were uninsured after 2014 by nearly 50%; however, racial disparities persisted. Other key findings are as follows: 1) race was a significant predictor of being uninsured, with non-Hispanic Black men having 30% greater odds than non-Hispanic White men of being uninsured and 2) non-Hispanic Black men had 25% lower odds than non-Hispanic White men of having a usual source of care. Other factors significantly associated with a greater likelihood of being uninsured were being part-time and intermittently employed and living in a Southern state. Factors significantly associated with a greater likelihood of not having a usual source of care were education (i.e., completing high school, college degree) full-time, part-time, or intermittent employment, and region (living in the South or the West).While the ACA achieved one of its goals of increasing health insurance coverage for men of both racial groups examined in this study, the racial gap between non-Hispanic Black men and non-Hispanic White men did not close for the two outcomes of interest – being uninsured or having a usual source of care post-ACA. These findings have implications for policy and practice to improve health care access. Specific policy recommendations proposed include: 1) develop pathways to coverage for states that have yet to adopt Medicaid expansion and 2) use a multilevel approach to expand the proportion of men with a usual source of care that includes: a) disseminating educational messages to improve men's awareness of the value of having a regular source of care and b) facilitating health care delivery and payment reforms that incentivize health care institutions to increase the number of Black men who are meaningfully engaged with a regular source of care.