The Educational Gradient, Insurance Status, and the ACA: Assessing Racial Disparities in Mortality Risk (2000–2019)

• In Event: Sociology of Population Section Roundtables
  In Refereed Roundtable (60 minute): Table 1. Health Disparities

Abstract

This study investigates the interplay between educational attainment, insurance status, and mortality risk, with a specific focus on whether the implementation of the Affordable Care Act (ACA) reduced long-standing health inequities across diverse racial and ethnic populations. We examine the "protective effect" of education and evaluate the ACA's efficacy in closing mortality gaps.
Using the National Health Interview Survey (NHIS) Linked Mortality Files (2000–2019), we analyze mortality risks before and after the ACA's primary implementation period (2014–2018). We employ Cox Proportional Hazards Models to estimate hazard ratios (HR) for Non-Hispanic White, Non-Hispanic Black, Hispanic, and Asian subpopulations, adjusting for socioeconomic covariates and insurance status.
The results confirm a robust educational gradient: higher educational attainment significantly lowers mortality risk across all groups. College-educated individuals consistently exhibit the lowest hazard ratios compared to those with less than a high school education. While the ACA did not lead to a uniform shift in mortality hazards for the general population, we identify a significant race-specific intervention effect. Specifically, Non-Hispanic Black individuals showed a statistically significant reduction in mortality risk during the ACA period. This unique benefit was not observed to the same degree in other racial or ethnic groups, suggesting that the ACA’s expansion of access may have addressed specific barriers previously faced by the Black population.
To further clarify these mechanisms, future research will incorporate measures of chronic condition prevalence and specific barriers to medical care access to better understand the persistent "morbidity-mortality" gap.

Authors

• Ernesto F. L. Amaral, Texas A&M University-College Station

• Nai-Yu Chien, Texas A&M University-College Station

• Hui-Heng Cheng, Southwest Minnesota State University