Effects of the Affordable Care Act on racial and ethnic disparities in the use of preventive services among seniors

Background. Starting January 1^st, 2011 the Affordable Care Act (ACA) enhanced Medicare coverage for preventive services. We evaluate how these changes affect racial/ethnic disparities in the use of preventive services among older adults.

Design. Data includes seniors ages 65+ from the 2008-2012 Medical Expenditures Panel Survey. We examine utilization among Non-Latino Whites, Non-Latino Blacks, and Latinos, and distinguish between whether they have traditional or Managed-Care (MC) Medicare. We operationalize preventive services utilization using a sex-specific index (range=0-100%) based on nine services received within a year. We use propensity score weighting to generate equivalent traditional and MC samples, and difference-in-difference methods to examine reduction in disparities.

Results. Blacks and Latinos under both traditional and MC Medicare reported lower use of services compared to Whites, and both minority groups experienced more pronounced underuse under traditional Medicare. Post-ACA, disparities in use between minority and White seniors remained unchanged.

Conclusion: Two years post-ACA, disparities in preventive services use were unchanged. First, most minority seniors held insurance that already covered preventive services costs, and the uptake in annual wellness visits was insufficient to change rates of use. Second, minority seniors likely to benefit from ACA enhancements might not be as sensitive to cost-sharing as originally thought. Third, other fundamental barriers to minority utilization (e.g. awareness and health literacy) remain dominant despite favorable cost incentives. These short-term findings suggest that reducing disparities in preventive services use requires solutions beyond cost-sharing incentives.

This presentation is part of the symposium Research on Minority Aging from the RCMAR Network (#323590)