# National estimates of the impact of the affordable care act on healthcare utilization, outcomes and quality among hispanics

> **NIH NIH R01** · WAKE FOREST UNIVERSITY HEALTH SCIENCES · 2020 · $539,366

## Abstract

A central policy assumption in the U.S. today is that expanding health insurance coverage will improve
access to health care, improve health outcomes, and make each more equitable for all Americans. Despite
its uncertain future, the Affordable Care Act (ACA) of 2010, "the most important legislation in health care
since the passage of Medicare and Medicaid", holds great promise for reducing racial/ethnic disparities in
healthcare access and population health.
 With the objective of evaluating the impact of the 2014 ACA coverage expansion on racial/ethnic
disparities in healthcare access, utilization, outcomes and quality, the proposed study has three foci.
First, we will examine measures based on actual healthcare inpatient and emergency department (ED)
utilization. Second, to better focus on Hispanics, the largest racial/ethnic minority with higher uninsurance
rate (41%) than among non-Hispanic whites (15%), non-Hispanic blacks (21%) and Asians (26%), we will
develop a near-national database by combining state inpatient discharge data from 22 states that together
account for over 88 percent of the national Hispanic population; corresponding ED data is available from a
subset of 13 states. Third, far from being an uniform intervention, ACA expansion engendered wide
variation in implementation, particularly across states; we will evaluate how reform effects among Hispanics
are modified by language barriers, national origin, baseline uninsurance, state Medicaid generosity, and
provider availability.
 To estimate changes associated with the 2014 ACA insurance expansion by race/ethnicity, we will use
a difference-in-differences design, wherein pre-expansion (2010-2013) to post-expansion (2014-2017)
changes in the study outcome measures are contrasted with those in a comparison cohort that experienced
no insurance expansion. Our specific aims are to estimate the changes associated with ACA coverage
expansion in rates of (1) ambulatory care sensitive condition admissions and ED visits, (2) major elective
procedures, (3) inpatient mortality and 30-day readmission, and (4) use of safety-net hospitals vs. non-
safety-net hospitals, and disparities in such rates by race/ethnicity. We will examine changes in outcomes
among subgroups of Hispanics by English language proficiency, national origin, sex and socioeconomic
status.
 Our proposal has unique strengths: the data used represents a near-national population of Hispanics; it
delineates impact across vulnerable subgroups of Hispanics; it identifies the role of potential facilitating and
inhibiting factors, such as, provider availability and state Medicaid policy.

## Key facts

- **NIH application ID:** 10026531
- **Project number:** 7R01MD011594-03
- **Recipient organization:** WAKE FOREST UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Amresh D Hanchate
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $539,366
- **Award type:** 7
- **Project period:** 2018-04-20 → 2022-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10026531

## Citation

> US National Institutes of Health, RePORTER application 10026531, National estimates of the impact of the affordable care act on healthcare utilization, outcomes and quality among hispanics (7R01MD011594-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10026531. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*