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

Introduction

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.

Methods

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).

Results

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.

Conclusion

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.