Reducing Child Health Disparities with Health Policies: Is Health Reform Enough?

Thesis (Ph.D.)--University of Washington, 2018Understanding whether healthcare policies can narrow and eliminate racial/ethnic disparities in health care access and utilization is an important public health issue. This dissertation examines whether two reforms, the Massachusetts (MA) health care reform law (Chapter 58) and the Patient Protection and Affordable Care Act (ACA), reduced racial/ethnic-related disparities in health care access and utilization between Hispanic and NH-white children. The first aim of this study examined the long-term effects of the MA health reform on disparities in insurance access, utilization of care, and health status among Hispanic children compared to non-Hispanic white children. The second and third aims examined the short-term effects of the ACA on disparities among Hispanic children compared to non-Hispanic white children. The second aim evaluated the impact of the ACA on insurance access and utilization of health care, and the third aim examined ACA impacts on financial burden due to medical costs experienced by the child’s family. Data from the National Survey of Children’s Health and the National Health Interview Survey were evaluated before and after implementation of the MA health reform (aim 1) and the ACA insurance expansion in 2014 (aims 2 & 3). The study subjects were children ages 0 to 17 years old. The impact of insurance expansion through health reform on disparities was evaluated using a triple-difference (difference-in-difference-in-difference, or DDD) analysis, which controlled for events not captured by the covariates that can affect the outcomes. Each aim utilized a nonequivalent pretest/posttest comparison group study design. For the first aim, children living in Massachusetts were the intervention group, and children living in surrounding states (Rhode Island, New Hampshire, and Connecticut) were in the comparison group. For the second and third aim, the intervention group includes children who were not eligible for Medicaid/CHIP before reform and whose family income was