Affordable Care Act and Disparities in Health Services Utilization among Ethnic Minority Breast Cancer Survivors: Evidence from Longitudinal Medical Expenditure Panel Surveys 2008–2015

Abstract

Breast cancer is the most prevalent female cancer in the US. Incidence rates are similar for white and black women but mortality rates are higher for black women. This study draws on rich, nationally representative data, the 2008–2015 Medical Expenditure Panel Surveys, to estimate effects of the Affordable Care Act (ACA) on reducing disparities in and access to use of diagnostic and medical services for black and Hispanic breast cancer survivors. Random effects multinomial logit, flexible hurdle and Box-Cox estimation techniques are used. The robust estimates indicate that the ACA narrowed the racial/ethnic disparity in health insurance coverage, health care utilization and out-of-pocket prescription drug expenditures among breast cancer survivors. Gaps in uninsurance significantly declined for black and Hispanic survivors. Hispanic women generally and black breast cancer survivors specifically increased use of mammography services post-ACA. The ACA did not significantly impact disparities in physician utilization or out-of-pocket prescription drug expenditures for Hispanic survivors, while there were substantive improvements for black breast cancer survivors. The paper concludes with a discussion of the strengths and limitations of the ACA for reducing disparities and improving health outcomes for a growing population of breast cancer survivors in the US.