This dissertation seeks to understand how the Affordable Care Act has affected certain groups who had faced barriers to accessing health insurance prior to the law's implementation. One major goal of the Affordable Care and Patient Protection Act was to move the United States toward universal health care coverage by expanding access for many Americans who previously lacked health insurance. This will increase the total number of people in the insurance pool, which would generate more premiums for the insurance company and change the demographics of the pool.
Now under the new law, in states expanding the program, other adults who fall within 138% of the federal poverty line are also eligible for benefits (Wachino et al.). While a few of the mandates did not pass judicial review, a strong majority of the provisions were upheld.
Barriers to Access
In addition, because women were less likely to have employer-based coverage, they were also more likely than men to have insurance as a dependent of their spouse, with twenty-four percent of women listed as dependents, compared to sixteen percent of men ("Women's Health. These out-of-pocket expenses have potentially negative consequences for the overall health of the group, as high out-of-pocket expenses mean this group is less likely to receive preventive care or seek medical care when sick. Due to the challenges of Mere understanding and the ability to purchase insurance, many minorities face cultural differences that can make patients less likely to visit a doctor or seek medical care.
When people visit a doctor of a different race, they are more likely to report feeling dissatisfied after their doctor's visit, especially if they do not understand their diagnosis or if they do not understand the type of medical care they are receiving. Additionally, areas with larger Spanish-speaking residents will be more likely to have someone who could help in Spanish than an area without a larger Spanish-speaking population. People in these areas of the cities are also less likely to be insured and more likely to use emergency services as opposed to preventive and primary care services.
First, those who attend college are more likely to have stable employment with higher pay and more health benefits. Because those with higher education are more likely to use preventive screenings, diseases are more likely to be detected early compared to those with higher education. This would be most beneficial for minorities or lower socioeconomic classes, who are more likely to have chronic conditions that require long-term self-care.
Spanish speakers are more likely to find someone who speaks Spanish or programs that seek to mobilize and enroll other Spanish speakers compared to a smaller minority population such as North Koreans living in the United States.
Hypotheses
I expect to find that PUMAs with more Spanish speakers will have higher rates of current enrollment than PUMAs with fewer Spanish speakers. I expect to see that PUMAs with more white will show lower current registration rates than PUMAs with less white. I expect to see PUMAs with more Hispanics see more enrollment than PUMAs with less Hispanics.
I expect that PUMAs with more people of other ethnicities will see more actual registrations than PUMAs with fewer people of other ethnicities. I expect there will be more actual registrations at PUMAs with more African Americans than at PUMAs with fewer African Americans. I would expect higher percentages of actual enrollment at PUMAs with a higher percentage of urban than at PUMAs with a lower percentage of urban.
The marketplace will give groups greater access, so I would expect to see higher enrollment rates in PUMAs with more people with a high school diploma than in PUMAs with fewer people with a high school diploma. I would expect to see the PUMAs with more people with a few years of college to see higher enrollment than in PUMAs with fewer people with a few years of college. I would expect to see higher actual enrollment in PUMAs with more people in the middle age percentile than in PUMAs with fewer people in the middle age percentile.
I would expect to see more actual enrollment in PUMAs with more people in the upper 75th age percentile than in PUMAs with fewer people in the upper 75th age percentile.
Research Design
To analyze the relationship between Internet access and enrollment, I combined data from the Federal Communications Commission (FCC) and data on the percentage of PUMA's urban and rural demographics provided by the Missouri State Census Data Center. Data Center). The report defines upload speed as "the download speed from the end user to the Internet." Before 2014, ISPs reported data in terms of "speed tiers" such as high medium and low, but now ISPs report based on actual maximum and minimum upload and download speeds measured in megabits per second (Mbps). For my analysis, I looked at the maximum upload speed, which the FCC defines as the maximum advertised upload speed in that census block, which they divided into four upload speed categories: less than 1 Mbps, 1 to 2.9 Mbps, 3 to 5.9 Mb/s and 6 Mb/s and faster.
It is important to note that while the FCC is looking at the maximum speeds offered within census channels. Finally, to get a better understanding of how much each group accounted for the total enrollment share, I ran an expected values analysis.
Findings
The correlation in column 6 was positive, therefore PUMAs with more African Americans saw more actual enrollments than PUMAs with fewer African Americans. I expect higher numbers of actual registrations at PUMAs with more Spanish speakers than at PUMAs with fewer Spanish speakers. PUMAs with more Spanish speakers saw more actual enrollments than PUMAs with fewer Spanish speakers.
PUMAs with more other language speakers had more actual entries than in PUMAs with fewer other language speakers. For PUMAs with more households in the top 75th income bracket, I expect to find lower rates of actual enrollment than in PUMAs with fewer upper income households. PUMAs with more high school degree earners had more actual enrollment than PUMAs with fewer high school degree earners.
I expected to see that PUMAs with lower upload speeds will have lower actual signup rates than PUMAs with higher upload speeds. PUMAs with a higher percentage of cities experienced more actual enrollments than PUMAs with a lower percentage of cities. PUMAs with higher maximum upload speeds experienced more actual signups than PUMAs with lower maximum upload speeds.
PUMAs with higher percentages of urban had higher rates of actual enrollment than in PUMAs with lower percentages of urban. The tests showed that PUMAs with higher percentages of men had fewer actual entries than PUMAs with lower percentages of men. I expect to find PUMAs with more people in the bottom 25th percentile of nonelderly.
Limitations
Discussion and Conclusions
Before the passage of the ACA, about 16% of the country was uninsured, and by early 2016 that number had nearly halved, with about 8.5% of U.S. citizens remaining uninsured. Through marketplace enrollment, expansion of Medicaid, and expansion of parental coverage to age 26, nearly 20 million Americans have purchased insurance (“ObamaCare Enrollment Numbers”). The research conducted for this dissertation analyzed these enrollment numbers to see which groups have benefited and which groups still face barriers to accessing health insurance.
By looking at who was eligible to enroll and who actually enrolled in the marketplace, the results show that the Affordable Care Act appears to have been successful in moving the United States one step closer to universal coverage. I found increases in enrollment among women, African Americans, Hispanics and other ethnicities, as well as increases in enrollment across all ages, different education and income levels, and even across language barriers and urban environments. Whether due to a dislike of the ACA, a low priority on having health insurance, or other factors, men and whites were the only groups to consistently show negative enrollment rates.
These results are not too shocking given that men, whites, and the middle class are generally considered to have more opportunity and privilege and are generally not the primary targets of welfare programs. Despite an overall increase in insurance coverage for the 20 million Americans who benefit from the ACA, the legislation continues to be debated and is likely to see major repeals in the coming years under a Trump presidency. The impact that the ACA has had on the country is undeniable, whether for better or for worse.
Work Cited
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34;Methodology for Estimating the Number of People Eligible for Premium Tax Credits Under the Affordable Care Act." KFF.org. 34;State by State Estimates of the Number of People Eligible for Premium Tax Credits Under the Affordable Care Act ." KFF.org.
