A driving force for health equity

Research and Policy Impacts of the Affordable Care Act on Low-Income Latinos in Oregon Community Health Centers

By: MJ Dunne

When the Affordable Care Act (ACA) was implemented in 2014, many previously uninsured Americans were suddenly able to access preventive services and life-saving treatments through our nation’s community health centers (CHCs). In the United States, the likelihood of having health insurance is strongly associated with a person’s race, ethnicity, and income level. Because poverty and other social determinants can pose a risk to one’s health, OCHIN’s Research Department has been committed to evaluating this landmark policy and how it has changed the healthcare landscape over the last four years.

Under the direction of Dr. John Heintzman at Oregon Health and Science University (OHSU), OCHIN has partnered with the OHSU Department of Family Medicine to examine the impact of the ACA on low-income Latino populations in Oregon. This research portfolio has resulted in several high-impact publications that analyze racial and ethnic disparities in insurance status before and after implementation of the ACA, and racial and ethnic disparities in lipid screenings, cervical cancer prevention, and pneumococcal vaccinations over a five-year period. Dr. Heintzman’s analysis on OCHIN’s Oregon-based community health centers has the potential to effect health policy for immigrant, Latino, and Spanish-speaking populations across the nation. The results of these publications are summarized as follows:

  • In Oregon’s CHCs, Spanish-preferring Latinos made the largest gains overall in insurance status after Medicaid expansion. Prior to 2014, Spanish-preferring Latinos were less likely to be insured than English-preferring Latinos and non-Hispanic Whites.

  • In general, Oregon community health centers deliver equitable care with regards to preventive services such as cervical cancer screenings, and pneumococcal vaccinations between Latinos and non-Hispanic whites.

  • CHC populations, regardless of race, ethnicity, and preferred language, are still at risk for underutilization of these preventive services. Insurance status still plays a role in the uptake of these services.

  • These findings need to be repeated on a larger scale, but continue to build the evidence base that health care payment reform plus a community health center delivery model hold promise for reducing health inequities.

Dr. Heintzman’s current study, ‘Bettering Asthma Care in Kids (BACKGROUND),’ will dive deeper in to the OCHIN research data warehouse to explore community-level factors affecting the asthma care of low-income Latino children across the nation. This study will provide clearer links between care utilization and the built environment and can aid legislators and policy makers in making informed decisions around these environments.

As our health care system continues to change over the next decade, it is our hope that the existing health disparities and gaps in services decrease over time. The OCHIN Research Department is committed to providing policymakers with the up-to-date and timely research findings to help improve the lives of our nation’s most vulnerable people. We are dedicated to this mission and will continue to pursue research studies that are impactful to the clinicians and patients we serve.