The Impact of Race on Healthcare Coverage for Women in Louisiana and Mississippi
Article Sidebar
Main Article Content
Abstract
It is crucial to confront the problem of health inequity that Black women are experiencing. Black women have a higher risk of pregnancy-related complications and experience worse outcomes in cardiovascular diseases, diabetes, high blood pressure, and mental health. Even with the Affordable Care Act, Black women still may not have access to affordable health insurance. This study examines the impact of race on healthcare coverage for women in Louisiana, which expanded Medicaid, and Mississippi, which did not. The study uses a quasi-experimental analysis to compare insurance coverage across states using publicly available data from the 2010 and 2021 American Community Survey. A chi-squared test determined a significant correlation between race and insurance type in both states. Insurance coverage for Black women increased in Louisiana. Women in Mississippi made slight gains even without Medicaid expansion. Despite these gains, racial disparity among women persists. Policymakers should strive for affordable healthcare for all women, regardless of race and geography.
Downloads
Article Details
How to Cite
References
Cohen RA. Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2022. 2022; https://doi.org/10.15620/cdc:115983
US health care can’t afford health inequities [Internet]. Deloitte Insights. 2022 [cited 2023 Jun 8]. Available from: https://www2.deloitte.com/us/en/insights/industry/health-care/economic-cost-of-health-disparities.html https://doi.org/10.1089/jwh.2020.8868
Chinn JJ, Martin IK, Redmond N. Health Equity Among Black Women in the United States. J Womens Health. 2021 Feb 1;30(2):212–9.
Hoyert L. D. Maternal Mortality Rates in the United States, 2019 [Internet]. National Center for Health Statistics; 2021 Apr [cited 2023 Jun 25]. Available from: https://stacks.cdc.gov/view/cdc/103855
ACOG № 228 Obstet Gynecol. 2021.
Affairs (ASPA) AS for P. About the Affordable Care Act [Internet]. HHS.gov. 2013 [cited 2023 May 21]. Available from: https://www.hhs.gov/healthcare/about-the-aca/index.html
KFF.org. A Guide to the Supreme Court’s Decision on the ACA’s Medicaid Expansion [Internet]. KFF. 2012 [cited 2023 May 28]. Available from: https://www.kff.org/health-reform/issue-brief/a-guide-to-the-supreme-courts-decision/
Guerra-Cardus L, Lukens G. Last 11 States Should Expand Medicaid to Maximize Coverage and Protect Against Funding Drop as Continuous Coverage Ends. 2023;
Buchmueller TC, Levinson ZM, Levy HG, Wolfe BL. Effect of the Affordable Care Act on Racial and Ethnic Disparities in Health Insurance Coverage. Am J Public Health. 2016 Aug;106(8):1416–21. https://doi.org/10.2105/AJPH.2016.303155
Sommers BD, Chua KP, Kenney GM, Long SK, McMorrow S. California’s Early Coverage Expansion under the Affordable Care Act: A County-Level Analysis. Health Serv Res. 2016 Jun;51(3):825–45. https://doi.org/10.1111/1475-6773.12397
Courtemanche C, Marton J, Ukert B, Yelowitz A, Zapata D. Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States: Impacts of the Affordable Care Act. J Policy Anal Manage. 2017 Jan;36(1):178–210. https://doi.org/10.1002/pam.21961
Mazurenko O, Balio CP, Agarwal R, Carroll AE, Menachemi N. The Effects Of Medicaid Expansion Under The ACA: A Systematic Review. Health Aff (Millwood). 2018 Jun;37(6):944–50. https://doi.org/10.1377/hlthaff.2017.1491
Griffith K, Evans L, Bor J. The Affordable Care Act Reduced Socioeconomic Disparities In Health Care Access. Health Aff (Millwood). 2017 Aug;36(8):1503–10. https://doi.org/10.1377/hlthaff.2017.0083
Rudowitz R, Drake P, Tolbert J, Damico A. How Many Uninsured Are in the Coverage Gap and How Many Could be Eligible if All States Adopted the Medicaid Expansion? [Internet]. KFF. 2023 [cited 2023 May 28]. Available from: https://www.kff.org/medicaid/issue-brief/how-many-uninsured-are-in-the-coverage-gap-and-how-many-could-be-eligible-if-all-states-adopted-the-medicaid-expansion/
Buettgens M, Ramchandani U. 3.7 Million People Would Gain Health Coverage in 2023 If the Remaining 12 States Were to Expand Medicaid Eligibility. 2022;
Edward J, Mir N, Monti D, Shacham E, Politi MC. Exploring Characteristics and Health Care Utilization Trends Among Individuals Who Fall in the Health Insurance Assistance Gap in a Medicaid Nonexpansion State. Policy Polit Nurs Pract. 2017 Nov;18(4):206–14. https://doi.org/10.1177/1527154418759312
Rosenbaum S, Wilensky G. Closing The Medicaid Coverage Gap: Options For Reform. Health Aff (Millwood). 2020 Mar;39(3):514–8. https://doi.org/10.1377/hlthaff.2019.01463
Chaudry A, Jackson A, Glied SA. Did the Affordable Care Act Reduce Racial and Ethnic Disparities in Health Insurance Coverage? 2019;
Snowden LR, Graaf G, Keyes L, Kitchens K, Ryan A, Wallace N. Did Medicaid expansion close African American-White health care disparities nationwide? A scoping review. BMC Public Health. 2022 Aug 30;22(1):1638. https://doi.org/10.1186/s12889-022-14033-8
Hill L, Ndugga N, Artiga S. Key Data on Health and Health Care by Race and Ethnicity - Report [Internet]. KFF. 2023 [cited 2023 May 28]. Available from: https://www.kff.org/report-section/key-data-on-health-and-health-care-by-race-ethnicity-report/
Lines G, Mengistu K, LaPorte MRC, Lee D, Anderson L, Novinson D, Dwyer E, Grigg S, Torres H, Basu G, McCormick D. States’ Performance in Reducing Uninsurance Among Black, Hispanic, and Low-Income Americans Following Implementation of the Affordable Care Act. Health Equity. 2021 Dec;5(1):493–502. https://doi.org/10.1089/heq.2020.0102
Wehby GL, Lyu W. The Impact of the ACA Medicaid Expansions on Health Insurance Coverage through 2015 and Coverage Disparities by Age, Race/Ethnicity, and Gender. Health Serv Res. 2018 Apr;53(2):1248–71. https://doi.org/10.1111/1475-6773.12711
Buchmueller TC, Levy HG. The ACA’s Impact On Racial And Ethnic Disparities In Health Insurance Coverage And Access To Care: An examination of how the insurance coverage expansions of the Affordable Care Act have affected disparities related to race and ethnicity. Health Aff (Millwood). 2020 Mar 1;39(3):395–402. https://doi.org/10.1377/hlthaff.2019.01394
Adepoju OE, Preston MA, Gonzales G. Health Care Disparities in the Post–Affordable Care Act Era. Am J Public Health. 2015 Nov;105(S5):S665–7. https://doi.org/10.2105/AJPH.2015.302611
Daniel H, Erickson SM, Bornstein SS. Women’s Health Policy in the United States: An American College of Physicians Position Paper. Ann Intern Med. 2018 Jun 19;168(12):874–5. https://doi.org/10.7326/M17-3344
Lee LK, Chien A, Stewart A, Truschel L, Hoffmann J, Portillo E, Pace LE, Clapp M, Galbraith AA. Women’s Coverage, Utilization, Affordability, And Health After The ACA: A Review Of The Literature: A literature review of evidence relating to the Affordable Care Act’s impact on women’s health care and health. Health Aff (Millwood). 2020 Mar 1;39(3):387–94. https://doi.org/10.1377/hlthaff.2019.01361
Collins SRC, Doty MMD, Beutel SB, Gunja MZG. How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care [Internet]. New York, NY United States: Commonwealth Fund; 2017 Aug [cited 2023 May 26]. Available from: http://www.issuelab.org/permalink/download/28134 https://doi.org/10.15868/socialsector.28134
Daw JR, Sommers BD. The Affordable Care Act and Access to Care for Reproductive-Aged and Pregnant Women in the United States, 2010–2016. Am J Public Health. 2019 Apr;109(4):565–71. https://doi.org/10.2105/AJPH.2018.304928
Moss HA, Havrilesky LJ, Chino J. Insurance coverage among women diagnosed with a gynecologic malignancy before and after implementation of the Affordable Care Act. Gynecol Oncol. 2017 Sep;146(3):457–64. https://doi.org/10.1016/j.ygyno.2017.06.012
Phillips KA, Morrison KR, Andersen R, Aday LA. Understanding the Context of Healthcare Utilization: Assessing Environmental and Provider-Related Variables in the Behavioral Model of Utilization. 1998;
Rice TH, Andersen RM, Kominski GF. Changing the U.S. Health Care System: Key Issues in Health Services Policy and Management. John Wiley & Sons; 2011. 743 p.
Andersen RM. Revisiting the Behavioral Model and Access to Medical Care: Does it Matter? J Health Soc Behav. 1995 Mar;36(1):1. https://doi.org/10.2307/2137284
Johnston EM, Strahan AE, Joski P, Dunlop AL, Adams EK. Impacts of the Affordable Care Act’s Medicaid Expansion on Women of Reproductive Age: Differences by Parental Status and State Policies. Womens Health Issues. 2018 Mar;28(2):122–9. https://doi.org/10.1016/j.whi.2017.11.005
Narcisse MR, Shah SK, Hallgren E, Felix HC, Schootman M, McElfish PA. Factors associated with breast cancer screening services use among women in the United States: An application of the Andersen’s Behavioral Model of Health Services Use. Prev Med. 2023 Aug;173:107545. https://doi.org/10.1016/j.ypmed.2023.107545
Lederle M, Tempes J, Bitzer EM. Application of Andersen’s behavioural model of health services use: a scoping review with a focus on qualitative health services research. BMJ Open. 2021 May;11(5):e045018. https://doi.org/10.1136/bmjopen-2020-045018
Penchansky R, Thomas JW. The Concept of Access: Definition and Relationship to Consumer Satisfaction. Med Care. 1981 Feb;19(2):127–40. https://doi.org/10.1097/00005650-198102000-00001
Cu A, Meister S, Lefebvre B, Ridde V. Assessing healthcare access using the Levesque’s conceptual framework– a scoping review. Int J Equity Health. 2021 May 7;20(1):116. https://doi.org/10.1186/s12939-021-01416-3
Artiga S, Hill L, Damico A. Health Coverage by Race and Ethnicity, 2010-2021 [Internet]. KFF. 2022 [cited 2023 Jun 4]. Available from: https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-by-race-and-ethnicity/
Baumgartner J, Collins S, Radley D, Hayes S. How the Affordable Care Act (ACA) Has Narrowed Racial and Ethnic Disparities in Insurance Coverage and Access to Health Care, 2013‐18. Health Serv Res. 2020 Aug;55(Suppl 1):56–7. https://doi.org/10.1111/1475-6773.13406
Miller S, Wherry LR. Health and Access to Care during the First 2 Years of the ACA Medicaid Expansions. N Engl J Med. 2017 Mar 9;376(10):947–56. https://doi.org/10.1056/NEJMsa1612890