# The Affordable Care Act’s Role in Aging Disparities Before and After Medicare Eligibility

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $518,775

## Abstract

PROJECT SUMMARY / ABSTRACT
Despite recent gains in overall life expectancy in the US, racial/ethnic health disparities in older adults (age
≥65) persist and are widening. This includes disparities in health status, chronic disease burden, disability, and
life expectancy for Black and Hispanic older adults compared with whites. Our previous work has identified
mid-life (age 50-64) as a critical period when health disparities for racial/ethnic minorities are set and may
potentially be intervened upon. The Affordable Care Act coverage expansions of 2014 have shown promise for
reducing disparities in access and health, but the impact on middle-aged and older adults has been largely
understudied.
The overarching goal of this proposal is to examine whether exposure to ACA coverage (Medicaid and
Marketplace plans) and access to care for middle-aged adults (age 50-64) may affect downstream health
disparities in older adults (age ≥65). We will use two modeling approaches in all aims: a) interrupted time
series analysis to assess the impact of the entire ACA coverage expansion on racial/ethnic disparities before
vs. after 2014; and b) difference-in-differences (DID) analysis and event study models comparing Medicaid
expansion vs. non-expansion states estimated for each racial/ethnic group (Black, Hispanic, white) to assess
the specific impact of Medicaid on disparities. In all analyses, we will also examine heterogeneity of treatment
effects by individual-level intersecting identities (race, ethnicity, gender, socioeconomic status) and area-level
structural racism.
With this approach, we will achieve the following specific aims: 1) Assess how racial/ethnic disparities in
middle-aged adults’ health insurance coverage has changed before vs. after the ACA coverage expansions,
using the American Community Survey; 2) Estimate racial/ethnic disparities in middle-aged adults’ health care
access and out-of-pocket costs before and after the ACA coverage expansions, using the Health and
Retirement Study (HRS) and the Current Population Survey; and 3) Investigate racial/ethnic disparities in
middle-aged and older adults’ health, and older adults’ health care utilization and costs before and after the
ACA, using the HRS-linked Medicare data.
The proposed work is significant because, in a time of economic distress and worsening health disparities, it
will directly inform US health insurance policies to improve health equity for vulnerable populations. The
methods are innovative in using the natural experiment of the ACA and an explicit focus on structural racism to
understand whether the upstream policy intervention of the ACA that affected coverage of middle-aged adults
may impact trajectories of health and health care disparities of middle-aged and older adults as they age.

## Key facts

- **NIH application ID:** 10833651
- **Project number:** 5R01AG075160-03
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Renuka Tipirneni
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $518,775
- **Award type:** 5
- **Project period:** 2022-08-15 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10833651

## Citation

> US National Institutes of Health, RePORTER application 10833651, The Affordable Care Act’s Role in Aging Disparities Before and After Medicare Eligibility (5R01AG075160-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10833651. Licensed CC0.

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