In Low-Income Latino Patients, Post-Affordable Care Act Insurance Disparities May Be Reduced Even More than Broader National Estimates: Evidence from Oregon

Abstract

Background: Early survey evidence suggests a reduction of disparities in insurance coverage between Latinos and non-Hispanic Whites post-Affordable Care Act (ACA). These findings may not describe the insurance status of vulnerable, low-income Latino populations served in community health centers (CHCs) over the course of this policy change. Cross-sectional surveys also may be of limited use in describing longitudinal phenomena such as changes in health insurance status.

Methods: Using electronic health record (EHR) data, we compared the insurance status of N = 42,392 low-income patients served in 23 CHCs in Oregon, by race/ethnicity and language, over a period of 6 years straddling the implementation of ACA-related Medicaid expansion on January 1, 2014.

Findings: Prior to 2014, Spanish-preferring Latinos were more likely to be uninsured than English-preferring Latinos and non-Hispanic Whites. Among uninsured patients who returned for at least one visit in 2014, Spanish-preferring Latinos had the largest increase in insurance coverage rates, and all three racial/ethnic/language groups had similar rates of insurance coverage. There were no racial/ethnic/language differences between those who did and did not have visit in 2014.

Conclusion: Among previously uninsured low-income patients returning to Oregon CHCs, insurance disparities were eliminated after Medicaid expansion, especially in Spanish-speaking Latinos. Further study is needed to understand the elimination of insurance disparities in this cohort.

Keywords: Affordable Care Act; Community health centers; Health insurance; Hispanic/Latino Americans.

Conflict of interest statement

Conflicts of Interest: The authors declare that they have no conflicts of interest.

Figures

Fig. 1

Age-stratified pre-ACA (2009–2013) Insurance Distribution among Hispanic/Latino/Spanish, Hispanic/Latino/English, and non-Hispanic White cohorts

Fig. 2

Insurance and Visit Disposition in Low-income Oregon CHC patients before and after the ACA Medicaid Expansion

Fig. 3

Insurance distribution pre- (2009–2013) and post-ACA (2014) among patients aged 18–64 who had at least one community health center visit before and after ACA expansion (N = 13,335)