Access to Health Care Improving Among all Racial and Ethnic Groups Following Affordable Care Act; Additional Work Remains
Insurance rates improved substantially after individuals were able to obtain coverage through provisions of the Affordable Care Act, and the gains in access to care were greater among black and Hispanic adults than whites, according to the 2014 National Quality and Disparities Report released today by HHS' Agency for Healthcare Research and Quality (AHRQ).
This annual report on the nation's health care includes a section on measures of access to care that for the first time cover a period after implementation of the Affordable Care Act's Health Insurance Marketplaces. Data covering January to June 2014 show that the overall rate of "uninsurance"—a measure of access to care—decreased substantially to 15.6 percent in the second quarter of 2014 among those age 18 to 64 (from a high of 22.3 percent in 2010). Because the data run through June 2014, they capture enrollment gains only from the first open enrollment period in the Health Insurance Marketplaces. The second open enrollment period began on November 15, 2014, and is not captured in the report.
The decline in uninsurance was greater among blacks and Hispanics, who historically have had higher uninsurance rates compared with whites. For blacks, the uninsurance rate decreased from 24.6 percent in the last quarter of 2013 to 15.9 percent in the first half of 2014. During the same period, the uninsurance rate dropped from 40.3 percent to 33.2 percent for Hispanics, and the rate declined from 14.0 percent to 11.1 percent for whites.
"These findings indicate that the Affordable Care Act's Health Insurance Marketplaces is making health insurance available to millions of Americans who might otherwise have been uninsured," said AHRQ Director Richard Kronick, Ph.D.
The report, which features annual trends on more than 250 measures of quality, access and disparities covering a broad array of health care services and settings, also found that disparities among racial groups for certain health services have been reduced to zero. For example:
- Black children age 19-35 months received one or more doses of the measles-mumps-rubella vaccine at similar rates as other children, compared to 2009 when 88 percent of black children and 91 percent of white children received the vaccine.
- Hispanic adults with obesity received nutrition counseling and advice to eat fewer high-fat foods at similar rates as other adults with obesity, compared to 2004 when 41 percent of Hispanic adults and 50 percent of white adults received counseling.
- American Indian children received hepatitis B vaccines at similar rates as other children, compared to 2002 when 81 percent of American Indian children and 91 percent of white children received the vaccine.
The report also found an increase in the percentage of people who said they have a usual place to go for medical care. From January to June 2014, the percentage of people with a usual place to go for medical care stood at 89.3 percent for whites, 86.5 percent for blacks and 82.2 percent for Hispanics compared to 2013 when 88 percent of whites, 85 percent of blacks, and 79 percent of Hispanics had a usual place to go for medical care. However, compared with whites, blacks and Hispanics still had lower access to care for about one-half of the access measures tracked in the report, which include encountering difficulties or delays in receiving care.
Overall, the Quality and Disparities Report demonstrates that quality of care is improving, particularly for hospital care, and for measures that are being publicly reported by the Centers for Medicare & Medicaid Services. As reported by AHRQ in a December 2014 report, hospital care was safer in 2013 than in 2010, with 17 percent fewer harms to patients and an estimated 1.3 million fewer hospital-acquired conditions, 50,000 fewer deaths, and $12 billion in cost savings over three years (2011, 2012, 2013). However, quality is still far from optimal, with millions of patients harmed by care they receive, and only 70 percent of recommended care being delivered across a broad array of quality measures. The Affordable Care Act established an ambitious new framework to move our health care system away from rewarding health providers for the quantity of care they provide and toward rewarding quality.
The National Quality and Disparities Report is congressionally mandated and has been issued annually since 2003. Data are compiled from more than 40 national sources. The report provides a snapshot of health care quality and disparities through trend analyses from 2000-2002 to 2011-2012 (except for select measures of access to care, which are tracked through the first half of 2014, and for adverse events in hospitals, tracked through 2013). Because most data precede implementation of a majority of the health insurance expansions included in the Affordable Care Act, the report serves as a baseline for measuring progress in future years.
In addition, the report now tracks performance measures that align with the National Quality Strategy (NQS), which was mandated by the Affordable Care Act to improve the delivery of health care services, patient health outcomes and population health. Those priorities are patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. The 2014 report shows that quality has improved for most of the NQS priorities.
The report is available online at: http://www.ahrq.gov/research/findings/nhqrdr/index.html. Printed copies can be obtained by calling 1-800-358-9295 or by sending an email to firstname.lastname@example.org.