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
