Closing Racial Disparities Through the Affordable Care Act: Medicaid Expansion, Marketplaces, Federally Qualified Community Health Centers

通过《平价医疗法案》缩小种族差异：医疗补助扩张、市场、联邦合格的社区卫生中心

• 批准号: 10717603
• 负责人: LONNIE Roscoe SNOWDEN
• 金额: $ 42.95万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-20 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10717603
• 关键词: Address; Adult; Affect; Affordable Care Act; African American; African American population; Area; Automobile Driving; Black Populations; Caring; Characteristics; Country; County; Criminal Justice; Data; Data Sources; Disadvantaged; Disparity; Drug usage; Eligibility Determination; Enrollment; Equity; Federally Qualified Health Center; Future; Health; Health Insurance; Health Policy; Healthcare; Heterogeneity; Income; Individual; Institutional Racism; Institutionalization; Insurance; Insurance Coverage; Measures; Medicaid; Mental Health; Mental Health Services; Mental disorders; Mentally Ill Persons; Monitor; National Institute of Mental Health; Neighborhood Health Center; Not Hispanic or Latino; Outcome; Persons; Play; Policies; Population Heterogeneity; Poverty; Privatization; Provider; Qualifying; Racial Equity; Reporting; Research; Running; Shapes; Stigmatization; Strategic Planning; Structural Racism; Structure; Surveys; System; Time; Underserved Population; Unemployment; Uninsured; United States Health Resources and Services Administration; Work; aged; copayment; disparity reduction; ethnic diversity; federal policy; health disparity; health equity; improved; programs; psychological distress; racial disparity; racism; safety net; severe mental illness; sociodemographic variables; success; treatment disparity; uptake; waiver

Project Summary/Abstract The now established Affordable Care Act (ACA) afforded an opportunity to increase mental health coverage and treatment for African Americans and whites and to reduce disparities. By extending Medicaid coverage to adults with incomes at or below 138% of the Federal Poverty Line (FPL), providing purchase subsidies for adults with incomes between 100% and 400% FPL, and by increasing the supply of Federally Qualified Health Centers which provide considerable mental health care nationwide, the ACA can benefit uninsured African Americans with mental health problems especially. We know little about how much ACA policies increased coverage and treatment for mentally ill Blacks and whites. Using data from the National Survey on Drug Use and Health (NSDUH), the Health Resources and Services Administration and from various Medicaid and marketplace data sources this study asks, for the first time, the following: For persons aged 18-64 with Mild and Moderate Mental Illness (MMMI), Serious Mental illness (SMI), and Serious Psychological Distress (SPD), and after controlling for individual socio-demographic variables related to insurance uptake and/or receipt of mental health treatment and key state-level differences we ask: (1) How much did the ACA Medicaid expansion increase Medicaid coverage and reduce coverage disparities? How was disparity reduction limited by some states’ supplemental Medicaid requirements? (2) How much did increases in 1) ACA Medicaid coverage (2) greater FQHC availability increase but lack of other provider availability decrease mental health treatment for African Americans and reduce African American- white disparities? How much did ACA marketplaces for subsidized purchase increase private coverage and reduce disparities? How much did increases in 1) marketplace coverage (2) and greater FQHC availability increase, but lack of other provider availability decrease mental health treatment for African Americans and reduce African American-white disparities? The ACA is status quo, and it is important to provide evidence concerning African American-white mental health coverage and treatment disparity reduction to monitor progress and guide future disparity reduction policy and administrative actions.

项目概要/摘要 现已制定的《平价医疗法案》(ACA) 为改善心理健康提供了机会 为非裔美国人和白人提供保险和治疗，并通过扩大差距来减少差距。 医疗补助覆盖范围为收入等于或低于联邦贫困线 (FPL) 138% 的成年人，提供 为收入在 FPL 100% 至 400% 之间的成年人提供购买补贴，并增加供应 联邦合格的健康中心在全国范围内提供大量的心理保健服务， ACA 可以使没有保险、有心理健康问题的非裔美国人受益，但我们对此知之甚少。 关于《平价医疗法案》政策在多大程度上增加了患有精神疾病的黑人和白人的覆盖范围和治疗。 使用国家药物使用和健康调查 (NSDUH) 的数据，卫生资源和服务 这项研究首次要求行政部门以及各种医疗补助和市场数据源 以下内容：适用于 18-64 岁患有轻度和中度精神疾病 (MMMI)、严重精神疾病的人士 （SMI）和严重心理困扰（SPD），并在控制了个人社会人口统计之后 与保险参与和/或接受心理健康治疗相关的变量以及关键的州级差异 我们问：(1) ACA 医疗补助扩展增加了多少医疗补助覆盖范围并减少了多少覆盖范围 一些州的补充医疗补助要求如何限制差距的缩小（2） 1) ACA 医疗补助覆盖范围增加了多少 (2) FQHC 可用性增加但缺乏其他方面 提供者的可用性减少了非裔美国人的心理健康治疗，并减少了非裔美国人- ACA 补贴购买市场增加了多少私人覆盖率？ 1) 市场覆盖范围 (2) 和 FQHC 可用性提高了多少？ 增加，但缺乏其他提供者的可用性减少了非裔美国人和 减少非裔美国人与白人之间的差距？ ACA 是现状，提供证据很重要 监测非洲裔白人心理健康覆盖率和减少治疗差距 进展并指导未来缩小差距的政策和行政行动。