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 recently released by HHS' Agency for Healthcare Research and Quality (AHRQ).
This annual report on the nation's healthcare includes a section on measures of access to care that for the first time cover a period after implementation of the ACA’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). 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.
The report, which features annual trends on more than 250 measures of quality, access and disparities covering a broad array of healthcare services and settings, also found that disparities among racial groups for certain health services have been reduced to zero:
- 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.
The National Quality and Disparities Report is congressionally mandated and has been issued annually since 2003. Overall, the 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 and Medicaid Services.