Addressing Health Equity through the Permanent Risk Adjustment Program mandated by the Patient Protection and Affordable Care Act of 2010
Previous research have shown signficiant under-utilization of ambulatory care and signficiantly lower costs among black insured individuals 18-64 from 2014-2018. (1)
If these differences persist through the ACA risk adjustment program, under-utilization represents an arbitrage opportunity for insurance providers in the individual market.
This would represent how a history of systematic racism and barriers to care could be used for cost-containment measures with the beenfits of overall lower health care costs transferred among the larger population.
Health equity efforts should be focused on neutralizing arbitrage opporunties based on defacto discrimination and instead incentivize issuers to address disparities in access to care.
With the addition of race and zip code to the EDGE server in 2025, CMS will have the ability to reform the ACA risk adjustmenr program to improve these disparities
The purpose of this study is to identify how the ACA Risk Adjustment program interacts with known health disparities in health care utilization among raical groups.
This study uses publcily available data from the Medical Expenditure Panel Survey (MEPS) from Agency for Healthcare Research and Quality (AHRQ) (2), the Area Health Resource Files (AHRF) from the Health Reseources and Services Administration (HRSA) (3).
Evidence from this study can identify 1) Whether there is evidence that the phenomenon is present in the program 2) Avenues for reforming the program to eliminate the phenomonen
This analysis serves to fulfill part of the the requirements for the PhD in Public Health-Heath Services Research at the University of Florida.
Race_MEPS_Results(.md/.doc/.html) Results form an analysis of paid claims costs by race among marketpalce enrollees using variables relevant to the ACA risk adjustment program.
_archive Old Content kept for reference (untracked)
_code Code scripts used in the analysis labeled by function
_data Raw and staged data files used for analysis.
_docs Documentation, presentations, manuscripts, references.
_fig Tables, figures as single images or workbooks with results.
_tmp Temporary files (untracked)
_wrap Results organized by topic, subject, version, and time.
venv Virtual Python environment (untracked)
log.txt Log of activity by date and time
requirements_py.txt Portable list of python libraries used in virtual environment
requirements_R.txt Portable list of R libraries used in virtual environment
- Dickman SL, Gaffney A, McGregor A, et al. Trends in Health Care Use Among Black and White Persons in the US, 1963-2019. JAMA Netw Open. 2022;5(6):e2217383. doi:10.1001/jamanetworkopen.2022.17383
- https://meps.ahrq.gov/mepsweb/data_stats/download_data_files.jsp
- https://data.hrsa.gov/topics/health-workforce/ahrf
Andrew S. Cistola, MPH
andrewcistola@pm.me
2022 Nov 14 22:01