How Insurance Access Has Already Closed Racial Gaps

The Affordable Care Act was partly inspired by a smaller-scale law already in place—and this one has worked.

Photo by Shutterstock

By Chris Hoenig


Photo by Shutterstock

When Mitt Romney ran for President in 2012 on an anti–Affordable Care Act platform, he vowed to repeal the new healthcare law. But in 2006, as Governor of Massachusetts, he signed a statewide healthcare-reform law into effect that would later be used as a model for the Affordable Care Act.

Like the Affordable Care Act, Romney's bill expanded Medicaid for lower-income individuals and families, and required residents to purchase health insurance or face escalating fines.

Under the Massachusetts law, informally referred to as "Romneycare," racial gaps in access to surgery have been completely erased for minimally invasive procedures used to remove gallbladders and appendixes. "The Massachusetts experience provides a really unique and natural experiment to measure the effect of insurance expansion," said study author Dr. Andrew Loehrer of Massachusetts General Hospital in Boston (one of DiversityInc's Top 10 Hospital Systems). "At least here, it says increasing insurance coverage has a real effect on those disparities."

But Loehrer also added that the same approach might not completely close the nationwide gaps: "Massachusetts is unique among states for many reasons in terms of healthcare delivery."

Researchers credit the increase in insurance accessibility for erasing the gap, which had white residents five percentage points more likely to undergo laparoscopic surgery than Blacks or Latinos. They also compared the data to numbers from six other states: New York, New Jersey, Maryland, Arizona, Florida and Washington. In those states, the racial gap for minimally invasive surgery nearly tripled during the same time period.

"In this study, it's much more likely that people who have symptoms will go to the doctor sooner [after insurance expansion] and will be better candidates for the minimally invasive surgery," said Amresh Hanchate, an Assistant Professor at the Boston University School of Medicine. In the past, experts said, uninsured Blacks and Latinos would have waited until their conditions were too advanced to be handled with the minimally invasive procedures, which use small incisions, thin instruments and cameras to complete the needed work with minimal trauma to the body. These patients would have required more traditional "open" surgery.

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