Racial and Ethnic Disparities in Health Care Access and Utilization Under the Affordable Care Act

Objective: To examine racial and ethnic disparities in health care access and utilization after the Affordable Care Act (ACA) health insurance mandate was fully implemented in 2014. Research Design: Using the 2011-2014 National Health Interview Survey, we examine changes in health care access and utilization for the nonelderly US adult population. Multivariate linear probability models are estimated to adjust for demographic and sociodemographic factors. Results: The implementation of the ACA (year indicator 2014) is associated with significant reductions in the probabilities of being uninsured (coef=-0.03, P < 0.001), delaying any necessary care (coef=-0.03, P < 0.001), forgoing any necessary care (coef=-0.02, P < 0.001), and a significant increase in the probability of having any physician visits (coef=0.02, P < 0.001), compared with the reference year 2011. Interaction terms between the 2014 year indicator and race/ethnicity demonstrate that uninsured rates decreased more substantially among non-Latino African Americans (African Americans) (coef=-0.04, P < 0.001) and Latinos (coef=-0.03, P < 0.001) compared with non-Latino whites (whites). Latinos were less likely than whites to delay (coef=-0.02, P < 0.001) or forgo (coef=-0.02, P < 0.001) any necessary care and were more likely to have physician visits (coef=0.03, P < 0.005) in 2014. The association between year indicator of 2014 and the probability of having any emergency department visits is not significant. Conclusions: Health care access and insurance coverage are major factors that contributed to racial and ethnic disparities before the ACA implementation. Our results demonstrate that racial and ethnic disparities in access have been reduced significantly during the initial years of the ACA implementation that expanded access and mandated that individuals obtain health insurance.