Racial Differences in Insurance Stability After Health Insurance Reform

BACKGROUND: One of the potential benefits of insurance reform is greater stability of insurance and reduced coverage disparities by race and ethnicity. OBJECTIVES: We examined the temporal trends in insurance coverage by racial/ethnic group before and after Massachusetts Insurance Reform by abstracting records across two urban safety net hospital systems. RESEARCH DESIGN: We examined adjusted odds of being uninsured and incident rate ratios of gaining and losing insurance over time by race and ethnicity. We used billing records to capture the payer for each episode of care. SUBJECTS: We included data from January 2005 through December 2013 on patients with hypertension between the ages of 21 and 64 years. We compared four racial and ethnic groups: non-Hispanic White, non-Hispanic Black, non-Hispanic Asian and Hispanic. MEASURES: We examined individual patients’ insurance coverage status in 6 month intervals. We compared odds of being uninsured in the transition and post insurance reform period to the pre reform period, adjusting for age, sex, comorbidities practice location and education and income by Census tract. RESULTS: Among 48,291 patients with hypertension, reduction in rates of uninsurance with insurance reform was greater for Hispanic (29.7%), non-Hispanic Black (24.8%) and non-Hispanic Asian (26.8%) than non-Hispanic White (14.9%) patients. The odds of becoming uninsured were reduced in all racial and ethnic groups (OR 0.27–0.41). CONCLUSIONS: Massachusetts Insurance Reform resulted in stable insurance coverage and a reduction in disparities in insurance instability by race and ethnicity.