Will The Affordable Care Act (Aca) Improve Racial/Ethnic Disparity Of Eye Examination Among United States Working-Age Population With Diabetes?

This study aimed to examine and forecast the racial/ethnic disparity of eye examination rates among US adults with diabetes before and after the ACA. Working-age adults (18-64 years) with diabetes were extracted from the Medical Expenditure Panel Survey Household Component 2011. For the years 2014 to 2017 after the ACA, samples were simulated from the 2011 population using the bootstrap method. Insurance coverage rates were separately predicted for each racial/ethnic group based on the Congressional Budgeting Office report and the proportions of diabetes patients potentially qualified for Medicaid under the ACA. Racial/ethnic groups were dichotomized as non-Hispanic whites (NHW) and minorities. Eye examination was defined as reporting ≥1 dilated eye examinations. Eye examination rates were weighted to national estimates and compared between racial/ethnic groups for each year. Confidence intervals were collected using the percentile bootstrap method. After the ACA implementation, health insurance coverage is forecasted to increase from 90% in 2011 to 98% in 2014 among NHW and reach 99% in 2017. The minorities are forecasted to have a 15% expansion of insurance coverage from 2011 (81%) to 2014 (96%), and slightly grow to 98% in 2017. In 2011, 63% of NHW had eye examinations and forecast an increase to 66% in 2014 and 66% in 2017. While the eye examination rate among the minority population will increase from 56% in 2011 to 59% in 2014, and remain at 59% in 2017. The racial/ethnic differences in eye examination are forecasted to persist (ranging from 6.25% in 2016 to 6.54% in 2015). The ACA is projected to reduce disparity in health insurance coverage by larger expansion of health insurance for minority populations than for their white counterparts. The racial/ethnic differences in eye examinations for patients with diabetes existed before ACA and are forecasted to persist after the ACA.