Racial and Ethnic Inequities in Financial Hardship Among CVD Patients in the USA During the Pre- and Post-Affordable Care Act Era

Abstract

The Affordable Care Act (ACA) has substantially expanded access to health insurance coverage, resulting in a reduction in financial hardship, defined as ability to pay medical bills, among cardiovascular disease (CVD) patients in the post-ACA era. However, it is not known whether implementation of the ACA improved the racial and ethnic inequity in financial hardship among CVD patients. As such, using data from the 2011 to 2018 waves of the National Health Interview Survey (NHIS), this paper aims to assess the odds of facing financial hardship among non-Hispanic-White, -Black, -Asian, and Hispanic CVD patients, before and after the implementation of the ACA. Our sample consists of 12,688 CVD patients in pre-ACA (2011-2013), 9128 CVD patients in early (2014-2015), and 11,863 CVD patients in later phase of the ACA (2016-2018). We performed multivariable logistic regressions to examine how the odds, in favor of facing financial hardship, varied between non-Hispanic White and other race/ethnic categories across the pre- and post-ACA periods. Though the overall prevalence of financial hardship was reduced from 22 to 18%, a considerable disparity between Black and Hispanic, and White CVD patients persisted from pre-ACA to post-ACA periods. The odds of experiencing financial hardship for Black and Hispanic CVD patients were, respectively, 2.25 to 2.16 and 1.52 to 1.78 times that of their White counterparts across the periods. Though the ACA is a positive step towards improving healthcare access and affordability, further initiatives are needed to reduce inequities across racial and ethnic minorities.

Keywords: Affordable Care Act (ACA); Cardiovascular diseases (CVD); Financial hardship; Medical bill; Racial inequity.