This document discusses how health reform in Massachusetts from 2006 to 2009 impacted racial and ethnic inequities in health insurance coverage, access to care, and health outcomes. It finds that while absolute disparities in uninsurance rates declined for minorities after reform, relative disparities increased. The reform reduced disparities in access to regular care sources but disparities in certain medical procedures like PCIs and CABG either remained unchanged or increased for non-white groups compared to whites. Overall, the reform had mixed effects on reducing racial and ethnic inequities in health and healthcare.

1. Impact of Health Reform on
Racial and Ethnic Inequities
http://masscare.org

2. BCBSF: Prior to Reform (2006)

3. BCBSF: After Reform (2009)

4. 5 Surveys of Health Care Coverage
in Massachusetts

5. Measuring disparities (relative and
absolute)
• Absolute disparity: the number gap between
one social group and another (e.g. life
expectancy for blacks is 5 years lower than for
whites)
• Relative disparity: the percentage of the gap
between one social group and another e.g. life
expectancy for blacks is 15% lower than for
whites).

6. Disparities in Apple Consumption
During the Apple Crisis

7. Absolute Disparities During Apple
Crisis Declined Rapidly

8. Relative Disparities During the
Apple Crisis Increased Rapidly

9. Most Health & Health Care Trends
Improve for All Groups Over Time

10. Disparities in Insurance
Coverage

11. Range of Survey Estimates of Uninsurance Rates
Uninsurance Rates for Uninsurance Rates for
African-Americans and African-Americans and
Whites (Census/CPS) Whites (CDC/BRFSS)
18% 20%
16.0% 18.5% 18.3%
16% 15% 15.1% 18%
14% 16%
12% 11.0% 14%
10.0%
10% 12% 10.4%
9.8% 9.8%
10%
8% 6.7%
8.2% 5.9% 8%
6% 5.3% 8.6%
6% 7.0%
4% 5.0%
4.4% 4.2% 4% 5.2%
2% 4.0%
2% 3.3%
0% 0%
2004 2005 2006 2007 2008 2009 2005 2006 2007 2008 2009
Whites African-Americans Whites African-Americans

14. Range of Survey Estimates of Uninsurance Rates
Uninsurance Coverage for Uninsurance Coverage for
Hispanics and Whites Hispanics and Whites
(Census/CPS) (CDC/BRFSS)
25% 30%
20.1% 23.9% 23.9%
20% 18%
25%
17.8%
20.7% 20.0%
20%
15%
12.0% 15.4%
15%
10% 11.00%
10.0% 7.2%
5.6% 10%
8.2%
5% 8.6%
5.0% 5.3% 5% 7.0%
4.2% 5.2%
3.3% 4.0%
0% 0%
2004 2005 2006 2007 2008 2009 2005 2006 2007 2008 2009
Whites Hispanics Whites Hispanics

17. Disparities in Access to Care

18. Share Reporting No Regular Source of Care,
Before & After Health Reform (BCBSMF)
18%
15.8%
16%
14%
12.4%
12%
10.3%
10% 9.4%
8%
6%
4%
2%
0%
2006 2009
White Non-Hispanic Racial/Ethnic Minorities

19. Share Reporting No Regular Source of Care,
Before & After Health Reform (CDC/BRFSS)
25%
21.9%
20% 19.1%
15%
9.9%
10%
8.0%
5%
0%
2006 2009
White Non-Hispanic Racial/Ethnic Minorities

30. Disparities in Health
Outcomes

32. Odds Ratio for PCIs (Pulmonary
Coronary Interventions) by
Race/Ethnicity
2
1.5 1.28 1.55
1 1 1
0.83 0.89
0.5
0.59 0.62
0
Pre-Reform Post-Reform
Black Hispanics Asians Whites

33. Odds Ratio for CABG (Coronary
Artery Bypass Surgery) by
Race/Ethnicity
2 1.82
1.8
1.6 1.5
1.4
1.2
1 1 1
0.8 0.83 0.86
0.6
0.4 0.55 0.57
0.2
0
Pre-Reform Post-Reform
Black Hispanics Asians Whites