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News Americas

Young trauma patients still have to face racial disparities when it comes to health care provision due to large differences in their health insurance coverage. (Photograph: Rob Marmion/Shutterstock)
Apr 24, 2015 | News Americas

Study finds racial disparities in health care provision for young trauma patients

by Surgical Tribune

BOSTON, USA: The dependent care provision of the Affordable Care Act has allowed millions of young adults to retain health care coverage through their parents' insurance plans until age 26, but racial disparities in coverage persist for young African-Americans and Hispanics requiring trauma care, a recent study has found.

Before the dependent care provision of the act became law in September 2010, approximately 30 percent of young adults were uninsured, according to the Centers for Medicare and Medicaid Services. The lack of insurance was especially pronounced among ethnic minorities.

The dependent care provision requires private health insurance companies that offer employer-based coverage to continue covering dependent children up to age 26, instead of dropping them from coverage at around age 18. Within the first year of enactment of this provision, more than 2.5 million young adults had obtained health care coverage, according to the Department of Health and Human Services.

Dr. John W. Scott, a general surgery resident at Brigham and Women's Hospital in Boston and a research fellow at the hospital's Center for Surgery and Public Health, and his colleagues researched how well the dependent care provision addressed the ethnic disparities in health care coverage, particularly for young ethnic minority adults needing trauma care. Trauma is the No. 1 cause of death of people aged 15–34, according to the Centers for Disease Control and Prevention. "Ensuring adequate access to high quality care through health insurance coverage is a priority for policymakers and trauma surgeons alike," Scott and his colleagues wrote.

Using the National Trauma Data Bank, they analyzed data on two groups of patients who sought trauma care between 2007 and 2012. The first group included 529,844 young adults aged 19–25, who became eligible for health care coverage under the dependent care provision. The second group included 484,974 adults aged 27–34, who were not eligible for the provision. The two groups had similar demographics, insurance coverage rates, employment status, medical conditions, and injuries.

The researchers analyzed how the annual insurance status changed among 19- to 25-year-old African-American, Hispanic, and white patients before and after implementation of the dependent care provision. They then compared that information with insurance status for 26- to 34-year-olds in the same racial and ethnic groups.

They found that although the dependent care provision allowed more young trauma patients to have health care coverage, it did not close the racial gap in coverage. "White patients had lower pre-policy uninsured rates and greater coverage gains than did African-Americans and Hispanics," the study authors wrote. The National Trauma Data Bank analysis showed that the uninsured rates for 19- to 25-year-olds dropped by 4.9 percent for whites, but only by 2.9 percent and 1.7 percent for African-Americans and Hispanics, respectively.

"We were not completely surprised by these findings," Scott said. "The policy is based on whether you have parents with jobs that offer employer-based insurance. We know that if you're a minority you're less likely to have employer-sponsored health insurance."

Their results also showed geographic differences in the ethnic disparities. African-Americans in the Midwest and Northeast had the greatest reduction in uninsured young people. Hispanics also showed the greatest reduction in uninsured people in the Midwest. The most pronounced racial disparities from the change in coverage existed in the South and West. Scott noted that these regions also happen to be where many of the states that have not elected to expand Medicaid are located.

Under the Affordable Care Act, state governments can choose whether to expand eligibility for health coverage under Medicaid, the public health insurance program for low-income individuals and families. As of March, 29 states had decided to expand Medicaid, according to the Kaiser Family Foundation. Six states are still considering expansion and 16 states have decided against it.

"The dependent coverage provision is a good first step in expanding access to care, however, additional, complementary provisions—like the Medicaid expansion—could help to fill in these gaps we've identified. If access does not continue to improve, those left behind by the dependent care provision will have an even harder time catching up," Scott stated. "As surgeons, we like to believe that we don't think about insurance cards, and we don't care what the patient looks like. But there are plenty of data that suggest that insurance really matters for trauma patients. And as trauma surgeons, we should be concerned that this group—young ethnic minority trauma patients—may not benefit from efforts to improve access to care."

The study, titled "Racial and Regional Disparities in the Effect of the Affordable Care Act's Dependent Coverage Provision on Young Adult Trauma Patients," was published online on April 8 in the Journal of the American College of Surgeons ahead of print.

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