Impact of Health Reform onRacial and Ethnic Inequities

http://masscare.org

BCBSF: Prior to Reform (2006)

BCBSF: After Reform (2009)

5 Surveys of Health Care Coverage in Massachusetts

Measuring disparities (relative and absolute)

• Absolute disparity: the number gap between one social group and another (e.g. life expectancy for blacks is 5 years lower than for whites)

• Relative disparity: the percentage of the gap between one social group and another e.g. life expectancy for blacks is 15% lower than for whites).

Disparities in Apple Consumption During the Apple Crisis

Absolute Disparities During Apple Crisis Declined Rapidly

Relative Disparities During the Apple Crisis Increased Rapidly

Most Health & Health Care Trends Improve for All Groups Over Time

Disparities in Insurance Coverage

15% 15.1%16.0%

6.7%

4.4%

5.9%

11.0%

8.2%

10.0%

5.0%

5.3%

4.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

2004 2005 2006 2007 2008 2009

Uninsurance Rates for African-Americans and Whites (Census/CPS)

Whites African-Americans

18.5% 18.3%

9.8% 9.8% 10.4%

8.6%

7.0%

5.2%

3.3%4.0%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

2005 2006 2007 2008 2009

Uninsurance Rates for African-Americans and Whites (CDC/BRFSS)

Whites African-Americans

Range of Survey Estimates of Uninsurance Rates

18% 17.8%

20.1%

7.2%5.6%

12.0%

11.00%

8.2%10.0%

5.0% 5.3%4.2%

0%

5%

10%

15%

20%

25%

2004 2005 2006 2007 2008 2009

Uninsurance Coverage for Hispanics and Whites

(Census/CPS)

Whites Hispanics

8.6%7.0%

5.2%3.3% 4.0%

23.9% 23.9%

20.7%

15.4%

20.0%

0%

5%

10%

15%

20%

25%

30%

2005 2006 2007 2008 2009

Uninsurance Coverage for Hispanics and Whites

(CDC/BRFSS)

Whites Hispanics

Range of Survey Estimates of Uninsurance Rates

Disparities in Access to Care

12.4%

10.3%

15.8%

9.4%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

2006 2009

Share Reporting No Regular Source of Care, Before & After Health Reform (BCBSMF)

White Non-Hispanic Racial/Ethnic Minorities

9.9%

8.0%

21.9%

19.1%

0%

5%

10%

15%

20%

25%

2006 2009

Share Reporting No Regular Source of Care, Before & After Health Reform (CDC/BRFSS)

White Non-Hispanic Racial/Ethnic Minorities

Disparities in Health Outcomes

0.59 0.62

0.83 0.89

1.28 1.55

1 1

0

0.5

1

1.5

2

Pre-Reform Post-Reform

Odds Ratio for PCIs (Pulmonary Coronary Interventions) by

Race/Ethnicity

Black Hispanics Asians Whites

0.55 0.57

0.83 0.86

1.5

1.82

1 1

00.20.40.60.8

11.21.41.61.8

2

Pre-Reform Post-Reform

Odds Ratio for CABG (Coronary Artery Bypass Surgery) by

Race/Ethnicity

Black Hispanics Asians Whites