Abstract

Background

Health law known as the Affordable Care Act (ACA) was passed in 2010 and implemented in 2014 in the U.S. It was intended to reduce cost burdens to health coverage and care.

Purpose

Self-reported health coverage gaps and cost barriers to physical, mental, dental care, and prescription medications of U.S adults before and after the implementation of the ACA in 2014 were examined to determine impacts of health reform on marginalized populations.

Methodology

Cross-sectional secondary data analysis was conducted using National Health Interview Survey Data from the Integrated Public Use Microdata Set (2010-2017). The 140,341 surveys represented an average of 138 million adults (26-64 years of age) annually over eight years. Analysis using SAS 9.4 included pre/post ACA comparisons using cross tabulation with design-adjusted Chi-Square on categorical variables and iv survey-adjusted multivariable logistic regression models to examine barriers in care preceding 12 months (yes or no). Interaction models were examined to compare joint effect of ACA on cost barriers to care with selected respondent characteristics.

Results

There were 15.7% survey respondents reporting health insurance coverage gaps pre-ACA and 9.9% post ACA. Similarly, 9.7% respondents reported experiencing cost barriers to health services pre-ACA and 7.0% reported cost barriers post ACA. Regression indicated limited changes in odds of experiencing health coverage gaps and cost barriers to healthcare services among marginalized groups post ACA. Hispanics and American Indian/Alaskan Natives were more likely to experience insurance gaps after 2014. Unmarried adults were twice as likely to have insurance gaps after the ACA, as those below 200% FPL. Cost barriers to physical, mental, dental, and prescription medications showed similar results despite odds slightly decreasing across services post ACA. Living under poverty remained the biggest predictor of accessing health services for U.S. adults.

Policy Implications

Factors such as race and poverty are measures of exposure to health risks but few policies consider these disparities as population threats. Study results suggest that while the ACA was successful overall, cost barriers to coverage and care remained post ACA, particularly for marginalized groups. Additional research and strengthening of ACA policies is needed to further improve population health.

LLU Discipline

Health Policy and Leadership

School

School of Public Health

First Advisor

Jim E. Banta

Second Advisor

Jisoo Oh

Third Advisor

Albin Grohar

Degree Name

Doctor of Public Health (DrPH)

Degree Level

Ph.D.

Year Degree Awarded

2021

Date (Title Page)

5-2021

Language

English

Library of Congress/MESH Subject Headings

Public health—United States; United States. Patient Protection and Affordable Care Act; Health services accessibility—United States; Minorities—Medical care—United States; Health care reform—United States

Type

Dissertation

Page Count

xii, 153 p.

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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